Impact of Retropubic vs. Transobturator Slings for Urinary Incontinence on Myofascial Structures of the Pelvic Floor, Adductor and Abdominal Muscles

Objective Using three-dimensional ultrasound (3D-US), we aimed to compare the tape position and the angle formed by the sling arms in different techniques of mid-urethral sling insertion for the surgical treatment of stress urinary incontinence, three years after surgery. In addition, we examined the correlations between the US findings and the clinical late postoperative results. Methods A prospective cross-sectional cohort study of 170 patients who underwent a sling procedure between May 2009 and December 2011 was performed. The final sample, with US images of sufficient quality, included 26 retropubic slings (tension-free vaginal tape, TVT), 42 transobturator slings (tension-free vaginal tape-obturator, TVT-O), and 37 single-incision slings (tension-free vaginal tape-Secur, TVT-S). The images (at rest, during the Valsalva maneuver, and during pelvic floor contraction) were analyzed offline by 2 different observers blinded against the surgical and urinary continence status. Group comparisons were performed using the Student t-test, the chi-squared and the Kruskal-Wallis tests, and analyses of variance with Tukey multiple comparisons. Results Differences among the groups were found in the mean angle of the tape arms (TVT = 119.94°, TVT-O = 141.93°, TVT-S = 121.06°; p < 0.001) and in the distance between the bladder neck and the tape at rest (TVT = 1.65 cm, TVT-O = 1.93 cm, TVT-S = 1.95 cm; p = 0.010). The global objective cure rate was of 87.8% (TVT = 88.5%, TVT-O = 90.5%, TVT-S = 83.8%; p = 0.701). The overall subjective cure rate was of 83.8% (TVT = 88.5%, TVT-O = 88.5% and TVT-S = 78.4%; p = 0.514). The slings were located in the mid-urethra in 85.7% of the patients (TVT = 100%, TVT-O = 73.8%, TVT-S = 89.2%; p = 0.001), with a more distal location associated with obesity (distal: 66.7% obese; mid-urethra: 34% obese; p = 0.003). Urgency-related symptoms were observed in 23.8% of the patients (TVT = 30.8%, TVT-O = 21.4%, TVT-S = 21.6%; p = 0.630). Conclusions The angle formed by the arms of the sling tape was more obtuse for the transobturator slings compared with the angles for the retropubic or single-incision slings. Retropubic slings were more frequently located in the mid-urethra compared with the other slings, regardless of obesity. However, the analyzed sonographic measures did not correlate with the urinary symptoms three years after the surgery.

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The response of the abdominal muscles to pelvic floor muscle contraction in women with and without stress urinary incontinence using ultrasound imaging

Neurourology and Urodynamics ◽

10.1002/nau.20959 ◽

2010 ◽

Vol 30 (1) ◽

pp. 117-120 ◽

Cited By ~ 15

Author(s):

Amir Massoud Arab ◽

Mahshid Chehrehrazi

Keyword(s):

Urinary Incontinence ◽

Stress Urinary Incontinence ◽

Pelvic Floor ◽

Muscle Contraction ◽

Ultrasound Imaging ◽

Pelvic Floor Muscle ◽

Abdominal Muscles ◽

Pelvic Floor Muscle Contraction

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The importance of physiotherapy in the puerperium

10.25242/8868113820212397 ◽

2021 ◽

Author(s):

Karen de Carvalho Teixeira ◽

Manoela Motta Pontes ◽

Maria Luiza Lopes de Nogueira Alberto ◽

Thayane dos Anjos Rodrigues ◽

Luciano Matos Chicayban

Keyword(s):

Urinary Incontinence ◽

Pelvic Floor ◽

Anal Incontinence ◽

Randomized Clinical Trials ◽

Exercise Program ◽

Postpartum Women ◽

Abdominal Muscles ◽

Review Of The Literature ◽

Voiding Symptoms ◽

Pelvic Floor Strength

The gestational period promotes changes in the woman's body, so that the baby can develop in a healthy way in the uterus. These transformations can interfere in a woman's daily life. Physiotherapy promotes re-education of the abdominal muscles, analgesia in the perineum region, restoration of gastrointestinal function, in addition to helping them with psychological changes. To verify the benefits of physiotherapy in the puerperium. A non-systematic review of the literature was carried out, through randomized clinical trials, published between 1999 and 2018. The search involved the databases PubMed, MEDLINE, SciELO, LILACS and PEDro. The following keywords were used: postpartum physiotherapy. 6 RCTs were included. There was a significant decrease in pain in the treatment group in four studies, increase in strength of the pelvic floor muscles (PFM) and decrease in urinary incontinence in two studies, but 3 postpartum women presented voiding symptoms; in another study, there was a decrease in the score related to anal incontinence; in another study, immediate physiotherapy after delivery reduced abdominal diastasis. Postpartum physiotherapy, through an exercise program, contributes to pain reduction, increase in pelvic floor strength, decrease in urinary incontinence, anal incontinence and abdominal diastasis.

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Safety And Preliminary Efficacy of Magnetic Stimulation of Pelvic Floor with Hifem Technology in Urinary Incontinence

Medical & Clinical Research ◽

10.33140/mcr.03.02.10 ◽

2018 ◽

Vol 3 (2) ◽

Keyword(s):

Urinary Incontinence ◽

Pelvic Floor ◽

Magnetic Stimulation ◽

Muscle Tone ◽

Pelvic Floor Muscle ◽

Neuromuscular Control ◽

Ultrasound Elastography ◽

Functional Evaluation ◽

Muscle Injuries ◽

Stimulation Of

Introduction: BTL EMSELLA™ utilizes High-Intensity Focused Electromagnetic technology (HIFEM) to cause deep pelvic floor muscles stimulation and restoration of the neuromuscular control. Key effectiveness is based on focused electromagnetic energy, in-depth penetration and stimulation of the entire pelvic floor area. A single BTL EMSELLA™ session brings thousands of supramaximal pelvic floor muscle contractions, which are extremely important in muscle reeducation of incontinent patients. Objective: Prospective study to evaluate the safety and preliminary effectiveness of the use of BTL EMSELLA magnetic stimulation in urinary incontinence. Method: Thirty-two patients with light and moderate urinary incontinence were recruited to perform 6 sessions of BTL EMSELLA during three weeks of initial treatment. Follow-up after three months. The patients received sessions lasting 28 minutes, completing the different treatment protocols. Initially the patients underwent a quality of life test before and after treatment, evaluation with advanced ultrasound using elastography to measure the initial tissue's elasticity and be able to compare after treatment, clinical functional evaluation and urodynamic test. Results: No adverse reactions were observed. All the patients finished the treatment sessions. Two patients reported increased pain after treatment in the first session corresponding to a VAS scale greater than 5 with duration greater than three hours. The treatment was highly satisfactory in 84,4% of the patients. After the first three months the improvement was maintained in 77% of the patients. No muscle injuries were observed. Elastographic changes and improvement of muscle tone were detected by advanced ultrasound (elastography) in 100% of patients. Conclusions: BTL EMSELLA is safe, well tolerated and effective for the treatment of mild and moderate urinary incontinence. The observed elastographic changes demonstrate the improvement of pelvic floor muscle tone after treatment. A reduction in the symptoms of urinary incontinence was demonstrated. Recommendations: Continue increasing the number of cases for research and increase the variables that we have decided to incorporate in the next research section such as MRI and pressure calculation.

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