Therapy For Stress Urinary Incontinence Research Articles

Predictors of the efficacy of CO2 laser therapy for female stress urinary incontinence

Background: Predictors of the efficacy of a single-session of CO2 laser therapy for female stress urinary incontinence are important for pretreatment consultation. Thus, the objective of this study was to evaluate these predictors. Methods: All consecutive women who underwent vaginal CO2 laser therapy for stress urinary incontinence were prospectively enrolled. Results: The median duration of subjective improvement (defined as ≥1 on the global response assessment) was 18.3 months (95% confidence interval (CI): 12.1 to 18.3 months, n = 75). Multivariable analysis revealed that low voided volume (dL, hazard ratio [HR] = 0.707; area under the curve [AUC] = 0.66, cutoff value of voided volume ≤4.0 dL), high postvoid residual volume (dL, HR = 2.714; AUC = 0.60, cutoff value of postvoid residual volume ≥1.0 dL), and low functional profile length (HR = 0.956; AUC = 0.58, cutoff value of functional profile length ≤2.8 cm) were predictors of subjective failure. A logit(p) = 1.0 - 0.5 x (voided volume) + 0.9 x (postvoid residual volume) can be used to predict failure (HR = 1.775; AUC = 0.71, cutoff value of logit(p) ≥0.0). Pad weights decreased at 3 and 6-month follow-up visits. At 6 months, 8 women (21%) were cured (<1 g pad weight), and 16 women (42%) showed improvement (>50% decrease in pad weight). Overactive bladder symptoms improved at 3 and 6 months. However, there was no change in female sexual function from baseline. Conclusion: A low voided volume and high postvoid residual volume can be used to predict subjective failure after one session of transvaginal CO2 laser therapy. However, the subjective therapeutic effect may diminish within a median duration of 18 months.

Differentiated approach to the choice of therapy for stress urinary incontinence in women with pelvic floor dysfunction

BACKGROUND: Among the symptoms of pelvic floor dysfunction, urinary incontinence is common in young patients. Stress urinary incontinence disrupts psychological health, sexual and social life. The effectiveness of modern conservative treatments for mild stress urinary incontinence in women of reproductive and perimenopausal age is being studied to prevent disease progression and improve the quality of life. AIM: The aim of this study was a comparative assessment of the effectiveness of pelvic floor muscle training using the Tyulpan laser vaginal simulator and paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age with pelvic floor dysfunction. MATERIALS AND METHODS: We examined 82 patients aged 43.35 ± 6.25 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies, including voiding diaries, Urgency Bother Visual Analogue Scale, cough test, ultrasound of the urethrovesical junction and pelvic floor, 41 women were prescribed a course of remote pelvic floor muscle training under medical supervision using the Tyulpan laser vaginal simulator (group I). 41 patients underwent paraurethral injection of 4.0 ml of high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether (group II). The effectiveness of therapy was evaluated one, six and 12 months after the start of treatment. RESULTS: After one month, the absence of stress urinary incontinence episodes based on voiding diaries was found in 29.4% of patients in group I and in 85.4% of patients in group II (2.9 times more often) (p 0.001); after 12 months, in 73.1% of patients in group I and in 36.4% of patients in group II (half as often) (p = 0.011). After one month, a negative cough test was detected in 65.0% of women in group I and in 92.1% of women in group II (1.4 times more often) (p = 0.023). After six months, the results of treatment for stress urinary incontinence based on the cough test were not different and amounted to 80.0% in group I and 71.9% in group II (p = 0.725). When assessing the pelvic floor muscle strength using the Oxford Scale and perineometry, an increase in strength after one and six months was detected in 100% of patients in group I (p 0.001). Both techniques equally reduced urethral mobility as measured by ultrasound over the one-month follow-up. Pelvic floor muscle training more significantly improved the quality of life of women 12 months after the start of therapy (p 0.05). CONCLUSIONS: The introduction of high-density hyaluronic biopolymer leads to a rapid and pronounced positive result in the treatment of stress urinary incontinence and an improvement in the quality of life in the short term; it is recommended for patients interested in quickly achieving results, informed about the limited duration of the effect. Regular training of the pelvic floor muscles in biofeedback mode under the remote control of a doctor contributes to better results in the long term. This method is recommended for women who are able to contract the pelvic floor muscles and are ready for regular exercise.

Mechanisms of action of an intravesical balloon as a therapy for stress urinary incontinence

Aims:Previous studies have indicated that the intravesical placement of an air-filled balloon alleviates much of the symptoms caused by stress urinary incontinence (SUI) in women. However, the exact working mechanisms behind this therapy are not yet fully understood. The current study aims to elucidate the potential physiological mechanisms underlying this minimally invasive intervention. Methods:We have evaluated video urodynamic data in women undergoing this therapy (n = 5), during which participants were asked to cough with increasing intensity. For each participant, we have videos before insertion of the balloon and one week following insertion. We identified a frame in a resting situation in which the maximum horizontal and vertical bladder dimensions were measured. We expressed the maximum vertical diameter as a ratio of the maximum horizontal diameter. We then used custom-written scripts to identify the bladder and balloon in each frame of the video urodynamic investigation and subtracted information regarding the location of the bladder neck and diameters of the balloon. We then used this information to plot the displacement of the bladder neck and size of the balloon during coughing. Results:The diameters of the balloon were significantly decreased during coughing (p ≤ 0.05). We found a significant increase of the maximum vertical diameter expressed as a ratio of the maximum horizontal diameter before and after insertion of the intravesical balloon (p ≤ 0.05). The maximum displacement of the caudal bladder limit increased significantly after placement of the intravesical balloon was (p ≤ 0.05). Conclusions:Our results imply that the balloon compresses in response to increases in abdominal pressure, and the bladder obtains a significantly more vertically oriented shape after placement of the balloon. Moreover, it appears that placement of the balloon significantly increases the mobility of the bladder neck. The balloon is indicated to absorb some of the increases in intravesical pressure during episodes of high abdominal pressure. We propose that the balloon inwardly pushes the bladder wall upwards, causing the organ to acquire a more vertically oriented shape. Additionally, we postulate that this change in bladder shape will increase the mobility of the bladder neck, thereby increasing the kinking capability of the urethra.

Optimized electroacupuncture treatment for female stress urinary incontinence: study protocol for a multi-center randomized controlled trial.

Stress urinary incontinence (SUI) is a common condition that can severely affect women's life quality. Electroacupuncture (EA) has been proved to be an optional treatment for SUI, but the tolerance of EA becomes a factor affecting efficiency, which should not be ignored and needs to be solved urgently. The purpose of this study is to find out whether the use of alternating acupoints combination can solve this problem or not and provide an optimization of EA treatment for female SUI. This multi-center randomized controlled trial will enroll 360 patients with SUI. They will be randomly assigned to one of the three groups-sacral acupoints group (sacral group), abdominal acupoints group (abdominal group), or alternating acupoints group (alternating group)-at a 1:1:1 ratio. The patients will receive 18 sessions of EA treatment and will be followed up for 48 weeks after the treatment. The primary outcome measure of the study is the change of urine leakage at week 6. The secondary outcomes include the incontinence episode frequency (IEF), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), severity of SUI, patient self-evaluation of therapeutic effects, weekly usage of urine pads, ultrasonography of pelvic floor, specialty therapies for SUI, evaluation of discomfort during EA treatment, patient acceptability evaluation and adverse events related to intervention. This trial is specifically designed to offer an optimized EA treatment for female SUI, aiming to enhance their quality of life.Clinical trial registration: ClinicalTrials.gov, identifier ID:NCT05635669.

MP03-06 VAGINAL DELIVERY ALTERS THE MUSCLE FIBER COMPOSITION OF THE PELVIC FLOOR MUSCLES

You have accessJournal of UrologyCME1 Apr 2023MP03-06 VAGINAL DELIVERY ALTERS THE MUSCLE FIBER COMPOSITION OF THE PELVIC FLOOR MUSCLES Takeya Kitta, Yui Abe-Takahashi, Mifuka Ouchi, Hiroki Chiba, Madoka Hoguchi, Mio Togo, Naohisa Kusakabe, Hidehiro Kakizaki, and Nobuo Shinohara Takeya KittaTakeya Kitta More articles by this author , Yui Abe-TakahashiYui Abe-Takahashi More articles by this author , Mifuka OuchiMifuka Ouchi More articles by this author , Hiroki ChibaHiroki Chiba More articles by this author , Madoka HoguchiMadoka Hoguchi More articles by this author , Mio TogoMio Togo More articles by this author , Naohisa KusakabeNaohisa Kusakabe More articles by this author , Hidehiro KakizakiHidehiro Kakizaki More articles by this author , and Nobuo ShinoharaNobuo Shinohara More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003214.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: It is well known that transvaginal childbirth weakens the pelvic floor muscles (PFM) and pelvic nerves, leading to stress urinary incontinence (SUI). PFM training is recommended as Grade A conservative therapy for SUI. Thus, PFM play important roles in lower urinary tract functions. In our previous study, we reported that the distribution of fiber types in the PFM is altered beginning 1 to 4 weeks post vaginal distension (VD), leading to muscle atrophy. SUI after vaginal delivery is known to persist in approximately 2% of patients who have had a vaginal delivery, even after 2 months postpartum. Therefore, we hypothesized that the long-term SUI that occurs after vaginal delivery may be influenced by the fiber-type distribution of PFM. The purpose of this study was to examine the long-term histological changes in PFM in a rat model of VD. METHODS: Eighteen female Sprague-Dawley rats (248-335 g) were used in this study. They were divided into 3 groups: a sham group, 1 (1M) and 3 months (3M) post VD. Urethral pressure was measured as urethral baseline pressure (UBP) and amplitude of urethral response (A-URE) (cmH2O). Right side pubococcygeus muscle (Pcm) was sampled and wet weight to body weight was measured. Pcm frozen sections 10 mm thick were prepared and stained using succinate dehydrogenase (SDH) activity. Stained images were imported into a personal computer to identify muscle fiber type (Ⅰ, Ⅱa and Ⅱb) distribution. In addition, the cross-sectional area (CSA) (μm2) of each muscle fiber type was determined. One-way analysis of variance was performed to compare the data among 3 groups. P value of less than 0.05 was regarded to be statistically significant. The present study was conducted after being approved by Animal Study Facility Ethics Committee. RESULTS: UBP was not significantly different among the 3 groups. In A-URE, 1M group was significantly lower than in the sham (p < 0.05). The Pcm wet weight was significantly lower in the 1M and 3M groups compared to the sham group (p<0.05). The CSA of type Ⅰ fibers in the Pcm was significantly lower in the 1M group than in the 3M group (p<0.05). The CSA of Type Ⅱa and Ⅱb fibers was not significantly different among the 3 groups. The ratio of typeⅠ fibers was significantly lower in the 1M and 3M groups compared to the sham group. The ratio of type Ⅱa fibers was not significantly different among the 3 groups. The ratio of type Ⅱb fibers was significantly higher in the 1M and 3M groups than in the sham group (p<0.05). CONCLUSIONS: In the present study, at 3 months post VD, the urethral function improved, but there was a decrease in muscle wet weight of the Pcm and a change in muscle fiber composition (leading to a decrease in slow-twitch muscle response). This may be due to decreased muscle function due to atrophy of the PFM and changes in muscle composition when SUI occurs beyond 3 months after vaginal delivery. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e23 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Takeya Kitta More articles by this author Yui Abe-Takahashi More articles by this author Mifuka Ouchi More articles by this author Hiroki Chiba More articles by this author Madoka Hoguchi More articles by this author Mio Togo More articles by this author Naohisa Kusakabe More articles by this author Hidehiro Kakizaki More articles by this author Nobuo Shinohara More articles by this author Expand All Advertisement PDF downloadLoading ...

Secondary urethral sphincter function of the rabbit pelvic and perineal muscles.

Perineal and pelvic floor muscles play an important role in continence by providing mechanical support to pelvic organs. It is also known that the pubococcygeus muscle (PcM) contracts in the storage phase and is inactive during voiding, while the bulbospongiosus muscle (BsM) is active during the voiding phase. Recent evidence suggested an additional role of these muscles in supporting urethral closure in rabbits. However, the individual role of perineal and pelvic muscles as urethral sphincters is not well-defined. Here we evaluated the individual, sequential and synergistic roles of the PcM and BsM in assisting urethral closure and defined the optimal electrical stimulation parameters that can effectively contract these muscles and increase the urethral pressure (P ura ) in young nulliparous animals (n = 11). Unilateral stimulation of either the BsM or PcM at 40 Hz induced modest increases in average P ura (0.23 ± 0.10 and 0.07 ± 0.04 mmHg, respectively). Investigation on the changes in P ura evoked by stimulation frequencies between 5 and 60 Hz show that sequential contralateral PcM-BsM activation at 40 Hz induced a 2-fold average P ura increase (0.23 ± 0.07 mmHg) compared to that evoked by PcM stimulation. Simultaneous activation of PcM and BsM at 40 Hz also showed an increased average P ura (0.26 ± 0.04 mmHg), with a 2-fold increase in average P ura observed during the unilateral sequential PcM-BsM stimulation at 40 Hz (0.69 ± 0.2 mmHg). Finally, stimulation at 40 Hz of the bulbospongiosus nerve (BsN) induced an approximate 4-fold increase in average P ura (0.87 ± 0.44 mmHg; p < 0.04) compared to that elicited by BsM stimulation, confirming that direct nerve stimulation is more effective. Together, this study shows that in the female rabbit, both perineal and pelvic muscles support of the urethral function during continence, and that unilateral stimulation of the BsN at 40-60 Hz is sufficient to achieve maximal secondary sphincter activity. The results also support the potential clinical value of neuromodulation of pelvic and perineal nerves as bioelectronic therapy for stress urinary incontinence.

Advances in the molecular pathogenesis and cell therapy of stress urinary incontinence.

Stress urinary incontinence (SUI) is very common in women. It affects patients' mental and physical health, and imposed huge socioeconomic pressure. The therapeutic effect of conservative treatment is limited, and depends heavily on patient persistence and compliance. Surgical treatment often brings procedure-related adverse complications and higher costs for patients. Therefore, it is necessary to better understand the potential molecular mechanisms underlying stress urinary incontinence and develop new treatment methods. Although some progress has been made in the basic research in recent years, the specific molecular pathogenic mechanisms of SUI are still unclear. Here, we reviewed the published studies on the molecular mechanisms associated with nerves, urethral muscles, periurethral connective tissue and hormones in the pathogenesis of SUI. In addition, we provide an update on the recent progresses in research on the use of cell therapy for treating SUI, including research on stem cells therapy, exosome differentiation and gene regulation.

CO2 Surgical Laser for Treatment of Stress Urinary Incontinence in Women: A Randomized Controlled Trial

ABSTRACT The common condition of stress urinary incontinence (SUI) has a reported prevalence of 10% to 39% in adult women in most studies. Although treatment of SUI via surgical means is an option, factors such as adverse effects of surgery and mesh-related risks lead many to seek alternative options. In overweight and obese patients, lifestyle changes for improving SUI symptoms entail mainly weight loss. Although pelvic floor muscle training (PFMT) can lead to improvements, further treatment is often necessary. Because of this, interest is high for developing effective nonsurgical treatments for SUI. One such possible treatment is vaginal laser therapy, which has been used as treatment for various vaginal conditions. The authors therefore carried out a randomized controlled trial (RCT) comparing CO2 laser with sham treatment for SUI. This multicenter, participant-blinded, sham-controlled, parallel-group, superiority RCT involved participants from 2 hospitals in Southeast Melbourne in the outpatient setting. Patients aged 18 to 80 years experiencing symptomatic and objective SUI and seeking conservative management participated. Women with prior surgery for SUI were excluded. A positive cough stress test with a comfortably full bladder and uroflow was used to determine objective SUI. Participants lacking positive cough stress test were still eligible for study inclusion with a positive pad weight test in the absence of urgency incontinence symptoms. Intervention took place using FemTouch delivery system in conjunction with the AcuScan 120 Microscanner and the AcuPulse CO2 laser system for fractional treatment. Laser energy was delivered via a standard foot pedal in a fractional manner. The sham treatment used identical methods and settings but used an inactive pedal, which only made mechanical clicks and no electronic beeps. A total of 3 treatments were administered to participants, 4 weeks apart, with incrementally greater density settings. The primary outcome of the study was subjective SUI (defined as positive answers to the inquiries: “Do you leak when you cough or sneeze?” or “Do you leak when physically active/exercising?”). Secondary outcomes were assessed via the Patient Global Impression of Improvement, and International Consultation on Incontinence Questionnaire–urinary incontinence change, International Consultation on Incontinence Questionnaire-overactive bladder, the Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire, the Incontinence Impact Questionnaire–Short Form, and EQ-5D scores. In addition, adverse events (such as pain during the procedure as measured on a visual analog scale) and objective SUI were recorded. A sample size of 101 was chosen to provide 80% power to detect differences between groups for the primary outcome (even assuming a 10% rate of attrition). A total of 97 participants ultimately were treated. Randomization of participants occurred with equal probability to sham treatment or the CO2 laser using a computer-generated random sequence, which allocated participants to blocks of 4, 6, and 8. Unblinding of participants to their allocation occurred following the 3-month review. Participants had a mean age of 53 years and a mean body mass index of 26.1 kg/m2, and 90% were vaginally parous. Most participants had attempted PFMT either independently or under supervision. No detectable difference was found between the sham and active treatment arm in the primary outcome of leak with laughter or cough. Furthermore, there were no significant differences between groups with regard to any of the secondary, patient-reported outcomes of questionnaires. The authors tested the reliability of their masking by assessing whether patients could identify their allocation group. Between the 2 groups, 17 (54%) of the sham group and 15 (63%) of the active treatment group believed they received sham treatment. Adverse events were rare in both groups, with similar visual analog pain scores during treatment and only rare vaginal bleeding and urgency incontinence in both groups. Strengths of this study are several and include its blinded design and randomization methods. The primary outcome was focused on patient-reported outcomes. Responsive and validated questionnaires were utilized for assessment of secondary outcomes. Study limitations include a lack of blinding for investigators, which could have introduced an element of detection bias for SUI. In conclusion, no benefit was shown for 3 treatment sessions of the CO2 vaginal laser when compared with sham therapy. Additional trials with various laser modalities are necessary to determine whether this may produce varying results. Women considering CO2 vaginal laser therapy for SUI should be made aware of the lack of consistent high-quality evidence in support of this treatment.

Mesenchymal stem cell-based therapy for female stress urinary incontinence.

Stress urinary incontinence (SUI) adversely affects the quality of life of patients, while the currently available surgical and non-surgical therapies are not effective in all patients. Application of mesenchymal stem cells (MSCs) for regaining the ability to control urination has attracted interest. Herein, we reviewed the literature and analyzed recent studies on MSC-based therapies for SUI, summarized recent treatment strategies and their underlying mechanisms of action, while assessing their safety, effectiveness, and prospects. In addition, we traced and sorted the root literature and, from an experimental design perspective, divided the obtained results into four categories namely single MSC type therapy for SUI, MSC-based combination therapy for SUI, treatment of SUI with the MSC secretome, and other factors influencing MSC therapy. Although evidence demonstrates that the treatment strategies are safe and effective, the underlying mechanisms of action remain nebulous, hence more clinical trials are warranted. Therefore, future studies should focus on designing clinical trials of MSC-based therapies to determine the indications for treatment, cell dosage, appropriate surgical strategies, and optimal cell sources, and develop clinically relevant animal models to elucidate the molecular mechanisms underlying stem cell therapies improvement of SUI.

Stem-cell therapy in stress urinary incontinence: A review.

The incidence of urinary incontinence (UI) is approximately 10%-40% in women, affecting one to two hundred million women worldwide. Stress UI (SUI) is characterized by involuntary urination due to increased abdominal stress and urine leakage without bladder contraction. Surgical treatments include midurethral slings, bulking agents, and Burch colposuspension to restore urethral continence. Nevertheless, an optimal treatment for all types of incontinence has not yet been established. Stem-cell therapy has emerged as a novel treatment for many diseases. Stem cells can self-renew and can differentiate into other cell types. Adult stem cells are suitable for clinical applications because they can be easily obtained noninvasively or minimal invasively. Stem-cell therapy for SUI has been studied preclinically and clinically. Muscle-derived progenitors have been used to treat SUI by promoting the regeneration of rhabdomyosphincters. The human trial used transurethral injection of autologous muscle-derived stem cells to improve sphincter contractility and function. Other sources of stem cells have also been studied in SUI treatment, such as umbilical cord blood, amniotic fluid, bone marrow, urine, and adipose tissue. The success rate of stem-cell therapy for SUI ranges from 13% to 100%. This review aimed to summarize the current status of stem-cell treatments for SUI, with respect to clinical trials, cell types, transplantation routes, and dosage volume and frequency.

Effect of Electroacupuncture Added to Pelvic Floor Muscle Training in Women with Stress Urinary Incontinence: A Randomized Clinical Trial

BackgroundPelvic floor muscle training (PFMT) is a first-line conservative therapy for stress urinary incontinence (SUI). Electroacupuncture (EA) has been used to treat SUI recently. ObjectiveTo compare the effectiveness of PFMT + EA versus PFMT + sham EA for SUI in women. Design, setting, and participantsA prospective, multicenter, randomized, controlled clinical trial was conducted at four hospitals in China involving 304 women with SUI from May 20, 2014 to November 21, 2017. Data were analyzed from April 20 to December 21, 2018. InterventionParticipants were randomized to receive 8 wk of PFMT+ EA (n = 154) or PFMT + sham EA (n = 150). Outcome measurements and statistical analysisThe primary outcome was the change in the amount of urine leakage measured on a 1-hr pad test. Student’s t test, the χ2 test, and the Wilcoxon rank-sum test were used for data analysis. Results and limitationsAmong the 304 participants randomized, 286 completed the study. The mean age was 57.6 yr (standard deviation [SD] 8.9) for the PFMT + sham EA group and 57.2 yr (SD 9.1) for the PFMT + EA group. The mean urine leakage at baseline was 13.6 g for the PFMT + sham EA group and 13.9 g for the PFMT + EA group. After the 8-wk intervention, the PFMT + EA group had a greater decrease in mean urine leakage (−9.8 g) than the PFMT + sham EA group (−5.8 g) with a mean difference of 4.0 g (95% confidence interval [CI] 0.8–7.2). Significantly more patients experienced a ≥50% reduction in urine leakage and the mean number of incontinence episodes in 24 h in the PFMT + EA group than in the PFMT + sham EA group (26.3%, 95%CI 15.8–36.8%). The PFMT + EA group experienced better improvement in participant-reported SUI severity at 6 wk (p < 0.001) and 8 wk (p < 0.001) and self-evaluated therapeutic effects at 2–32 wk (p < 0.001) after the intervention. Lack of measurement of the amount of urine leakage during follow-up is a limitation. ConclusionsIn this randomized clinical trial, 8-wk combined treatment with PFMT + EA led to a greater improvement in SUI symptoms and better outcomes than with PFMT + sham EA. Patient summaryWe evaluated the effectiveness and safety of pelvic floor muscle training combined with electroacupuncture for stress urinary incontinence in women, Our results show that this is a promising therapeutic approach for the treatment of stress urinary incontinence.

The Role of Pessaries in the Treatment of Women With Stress Urinary Incontinence: A Systematic Review and Meta-Analysis.

Pessaries are an important conservative therapy for stress urinary incontinence (SUI), but few studies have comprehensively evaluated their utility. The objective of this study is to evaluate the existing evidence on the efficacy and safety of pessaries for the treatment of SUI. We searched for the terms "stress urinary incontinence" and "pessar/y/ies/ium" in PubMed, Embase, and Cinhal on June 10, 2020. Studies that characterized subjective and/or objective data were included. Studies performed in pediatric populations, pregnancy, and use of pessaries not for SUI were excluded. Two reviewers independently screened and assessed data quality and risk of bias according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Ten studies, including 376 patients, were included. In terms of subjective outcomes, 76% of 72 patients reported feeling continent after pessary treatment compared with 0% of 86 patients surveyed before pessary use (P < 0.0001). Both Urinary Distress Inventory and Incontinence Impact Questionnaire scores decreased significantly by 46.7% (n = 155 baseline, n = 139 follow-up; P < 0.0001) and 67.8% (n = 139 baseline, n = 107 follow-up; P < 0.0001), respectively. Significant objective measures associated with pessary use included increased urethral closure pressure (n = 122; g = 0.56; 95% confidence interval [CI], -0.66 to 1.77; P < 0.049) and decreased pad weight (n = 129 baseline; n = 118 follow-up; g = -0.89; 95% CI, -1.986 to 0.19; P = 0.009). Adverse events significantly decreased at greater than 6 months follow-up compared with less than 6 months follow-up, including pain (31.5%, n = 29/92 vs 14.3%, n = 5/35; P = 0.0513) and discomfort (50%, n = 46/92 vs 29.3%, n = 12/41; P = 0.0268). Based on both subjective and objective measures, pessaries are an effective conservative treatment option for SUI. This supports pessary use, though larger studies with longer-term follow-up are warranted.

Urethral injection of dedifferentiated fat cells ameliorates sphincter damage and voiding dysfunction in a rat model of persistence stress urinary incontinence

PurposeDedifferentiated fat (DFAT) cells are mature adipocyte-derived multipotent cells that can be applicable to cell-based therapy for stress urinary incontinence (SUI). This study developed a persistence SUI model that allows long-term evaluation using a combination of vaginal distention (VD) and bilateral ovariectomy (OVX) in rats. Then, the therapeutic effects of DFAT cell transplantation in the persistence SUI model was examined.MethodsIn total, 48 Sprague–Dawley rats were divided into four groups and underwent VD (VD group), bilateral OVX (OVX group), VD and bilateral OVX (VD + OVX group), or sham operation (Control group). At 2, 4, and 6 weeks after injury, leak point pressure (LPP) and histological changes of the urethral sphincter were evaluated. Next, 14 rats undergoing VD and bilateral OVX were divided into two groups and administered urethral injection of DFAT cells (DFAT group) or fibroblasts (Fibroblast group). At 6 weeks after the injection, LPP and histology of the urethral sphincter were evaluated.ResultsThe VD + OVX group retained a decrease in LPP with sphincter muscle atrophy at least until 6 weeks after injury. The LPP and urethral sphincter muscle atrophy in the DFAT group recovered better than those in the fibroblast group.ConclusionsThe persistence SUI model was created by a combination of VD and bilateral OVX in rats. Urethral injection of DFAT cells inhibited sphincter muscle atrophy and improved LPP in the persistence SUI model. These findings suggest that the DFAT cells may be an attractive cell source for cell-based therapy to treat SUI.

Vaginal Laser Therapy for Stress Urinary Incontinence: A Systematic Review of Prospective Randomized Clinical Trials.

The most common type of urinary incontinence in women is stress urinary incontinence (SUI) which negatively impacts several aspects of life. The newly introduced vaginal laser therapy is being considered for treating SUI. This systematic review aimed to evaluate the efficacy of vaginal laser therapy for stress urinary incontinence in menopausal women. We searched the following databases: MEDLINE (via PubMed), EMBASE, Cochrane Library databases, Web of Science, clinical trial registry platforms, and Google Scholar, using the MeSH terms and keywords [Urinary Incontinence, Stress] and [(lasers) OR laser]. In our systematic review, prospective randomized clinical studies on women diagnosed with SUI as per the International Continence Society's diagnostic criteria were included. The Cochrane Risk-of-Bias assessment tool for randomized clinical trials was used to evaluate the quality of studies. A total of 256 relevant records in literature databases and registers and 25 in additional searches were found. Following a review of the titles, abstracts, and full texts, four studies involving 431 patients were included. Three studies used CO2-lasers, and one used Erbium: YAG-laser. The results of all four studies revealed the short-term improvement of SUI following both the Erbium: YAG-laser and CO2-laser therapy. SUI treatment with CO2-laser and Erbium: YAG-laser therapy is a quick, intuitive, well-tolerated procedure that successfully improves incontinence-related symptoms. The long-term impact of such interventions has not been well established as most trials focused on the short-term effects.

Inkontinencia moču a Medilady

Introduction: Within the framework of the use of various aids for the therapy of urinary incontinence, a wide space has opened up for the autonomous activity of the nurse. In her own way, the nurse is the main point of communication for all other members of the team, including the doctor himself, precisely in the assessment and reporting of the information found. The paper analyzed the types of physical therapy for stress urinary incontinence and conducted research on a selected group of female respondents who used the patented Medilady rehabilitation aid in the treatment of incontinence. Objective: The objective of the contribution was to monitor the impact of urinary incontinence on the quality of life of women using the Medilady rehabilitation aid. Methodology: The research file consisted of female respondents with a diagnosis of stress urinary incontinence (SUI), who used the Medilady rehabilitation aid to strengthen the pelvic floor muscles for more than 90 days. Data collection took place between 08/2021 - 01/2022 at the Viennese Private Clinic in Vienna, after the agreement of the clinic management with the subsequent approval and publication of the questionnaire for the designated group of female respondents, in the form of quantitative research. 96 female respondents were approached. Of these, 81 questionnaires were completely filled out and returned. The data were processed by statistical analysis using the binomial test and the paired Wilcoxon test Results: The treatment of urinary incontinence in women with the rehabilitation aid Medilady is a relative novelty. This greatly limited the selection of suitable respondents for the conducted research. According to the selected criteria, 91% of the clients increased the weight of the weights, so we can evaluate that the pelvic floor was effectively strengthened in the specified cohort of clients. 71% of users reported no negative experiences with the use of Medilady. Conclusion: The limits of the research were in the relatively low number of respondents and the patented device Medilady, which is new in the treatment of urinary incontinence, where comparisons of results in professional studies were not available. Further research needs to be continued due to urinary incontinence and its impact on the quality of life of the woman herself.

Therapeutic massage in women with stress urinary incontinence: a pilot study.

Background: Stress incontinence affects 25–60% of women of all ages and causes constant discomfort, significantly lowering quality of life. The most common causes of urinary incontinence are weakened sphincter muscles or bladder failure. Aim of the study: The aim of this study was to assess the effectiveness of therapeutic massage therapy for stress urinary incontinence and to determine whether therapeutic massage can restore the normal function of the bladder sphincters. Material and methods: The study involved eleven women with a diagnosis of primary stress urinary incontinence, aged 50–79 years. The women attended therapeutic massage sessions twice a week for four weeks. A sanitary pad test was performed before starting and immediately after ending the therapy to verify its effectiveness. Results: In eight women, the amount of urine that leaked decreased after therapy. This result was statistically significant (p = 0.02). In three cases, urine leakage was reduced to zero. Conclusions: Therapeutic massage, acting locally, improves the function of the bladder sphincters, their flexibility and the ability to contract and relax. Massage eliminates or significantly reduces the symptoms of stress urinary incontinence.

Regenerative Medicine in Urogynecological Services: Opportunities in Cases of Stress Urinary Incontinence

Stress urinary incontinence (SUI) is a case that often occurs in women. The handling of this case is not yet fully effective, even though the challenge of health care is to provide quality services and adjust to the needs of the patient. The purpose of this study was to examine the effectiveness of regenerative medicine applied in urogynecology especially in stress urinary incontinence cases as a preliminary study. A selective database search of PubMed, and Google Scholar was conducted to validate the effectiveness of regenerative medicine in urogynecology especially urinary stress incontinence. The search included experimental research, written in English, and has Leak Point Pressure assessment data in the results analysis. Research involves both animals and humans. The search used the following keywords in various combinations: 'stem cell therapy', 'cell-based therapy for SUI', 'regenerative medicine for SUI', and 'tissue engineering'. LPP is an assessor of the success of SUI's services. Most of the studies explored the success and potential of stem cell utilization in cases of stress urinary incontinence even with different types of stem cells. Future studies need to test or experiment the manufacture of stem cell products that can be applied more easily and in the long term.&#x0D; Keywords: Stress urinary incontinence, stem cell, regenerative medicine

Efficacy of Mind-Body Therapies for the Treatment of Urinary Incontinence in Women: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Introduction: The efficacy of mind-body therapies to manage urinary incontinence in women is outdated and inconclusive. This review aims to determine the efficacy of mind - body therapies for Stress Urinary Incontinence (SUI) in women. Methods: The databases AMED, CINAHL, EMBASE, Medline, Physiotherapy Evidence Database (PEDro), PubMed, Scopus, and Web of Science, were searched from database inception until May 2020. Randomized controlled trials comparing mind-body therapies to control were included. The methodological quality and the quality of the evidence were evaluated using the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations, Assessment, Development, and Evaluation tool, respectively. The risk of bias was assessed using the Cochrane risk of bias tool. Results: Six studies were included in the review. Pooled analysis of data from two studies of low to high methodological quality, low-grade evidence revealed a statistically significant decrease in the number of SUI episodes in the yoga group than in the control group (MD 0.83 [95% CI-1.64 to 0.02]; p=0.04). Pooled analysis of three methodologically low-quality, very low-grade studies revealed no significant difference between groups receiving Paula exercise and pelvic floor muscle training on grams of urine lost in the 1h pad test (MD 0.15 [95% CI-1.15 to 1.46] p=0.82). Conclusions: This review found hatha yoga poses intended to address the pelvic floor as beneficial for managing SUI in women. Yoga is a low-risk intervention and therefore it may be considered for clinical use. The effect of Paula exercise on SUI remains inconclusive.

Safety and efficacy of vaginal laser therapy for stress urinary incontinence: a meta-analysis.

Laser therapy has recently been proposed as a novel treatment for stress urinary incontinence (SUI) due to offering several advantages. This study aimed to evaluate the safety and efficacy of laser treatment of SUI by a meta-analysis. The systematic review registration number is INPLASY202080001. A comprehensive search to identify relevant studies was conducted using the PubMed, Embase, Cochrane Library, CNKI, VIP and Wanfang databases with a cutoff date of 1 November, 2020. Outcome measures were extracted based on subjective and objective indexes, including International Consultation on Incontinence Questionnaire-Short Form (ICIQ-UI-SF), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), and objective measurements "1-hour pad test" (1-hour test under standardized conditions). Score changes before and after treatment were evaluated through meta-analysis. Subgroup analysis was performed according to geographic region, type of urinary incontinence (UI), severity of UI, age, and body mass index (BMI). Sixteen published clinical research studies, involving 899 patients with SUI, were included in this study. After laser treatment, the change in the ICIQ-SF score at 1, 2, and 6 months was -5.49 (95% CI: -6.74--4.24; I2=91%, P<0.01), -4.97 (95% CI: -6.24--3.71), and -5.48 (95% CI: -6.15--4.81), respectively. The improvement in 1-hour pad weight test results at 1, 3, and 12 months post treatment was -5.59 (95% CI: -6.93--4.25), -4.96 (95% CI: -6.73--3.20), and -5.82 (95% CI: -6.77--4.87), respectively. The PISQ-12 score increased by 5.39 (95% CI: 1.20-9.58) following treatment. Subgroup analysis identified the type and severity of UI as the potential source of heterogeneity. Adverse effects were reported in 6 of the 16 trials and affected only a small number of patients. Most adverse events were mild or moderate and required no medical intervention or resolved in a few days. Vaginal laser therapy appears to be a safe, effective, and minimally invasive treatment option for SUI that can be well tolerated by patients.

Rapid and precise delivery of cells in the urethral sphincter complex by a novel needle-free waterjet technology.

To investigate the therapy of stress urinary incontinence in a preclinical setting cells were injected into the urethrae of minipigs; however, cells injected by William's needle were frequently misplaced or lost; thus, we investigated if needle-free cell injections using a novel waterjet technology facilitates precise injections in the urethral sphincter complex. Porcine adipose tissue-derived stromal cells (pADSCs) were isolated from boars, expanded, labelled, and injected in the sphincter of female pigs by waterjet employing two different protocols. After incubation for 15min or 3days, the urethrae of the pigs were examined. Injected cells were visualised by imaging and fluorescence microscopy of tissue sections. DNA of injected male cells was verified by polymerase chain reaction (PCR) of the sex-determining region (SRY) gene. Cell injections by William's needle served as controls. The new waterjet technology delivered pADSCs faster and with better on-site precision than the needle injections. Bleeding during or after waterjet injection or other adverse effects, such as swelling or urinary retention, were not observed. Morphologically intact pADSCs were detected in the urethrae of all pigs treated by waterjet. SRY-PCR of chromosomal DNA and detection of recombinant green fluorescent protein verified the injection of viable cells. In contrast, three of four pigs injected by William's needle displayed no or misplaced cells. Transurethral injection of viable pADSCs by waterjet is a simple, fast, precise, and yet gentle new technology. This is the first proof-of-principle concept study providing evidence that a waterjet injects intact cells exactly in the tissue targeted in a preclinical in vivo situation. To further explore the clinical potential of the waterjet technology longer follow-up, as well as incontinence models have to be studied.