Development of a plan for the diagnosis and treatment of urinary stress incontinence

Green, Thomas H.

doi:10.1016/s0002-9378(16)35894-x

Cited by 175 publications

(60 citation statements)

References 5 publications

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“…Green [2] reported that VCUG detection of urethrocele correlated directly with urinary stress incontinence. On the other hand, Greenwald et al [7] …”

Section: Discussionmentioning

confidence: 99%

Voiding cystourethrography in female stress incontinence.

Pelsang¹,

Bonney²

1996

American Journal of Roentgenology

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“…Green [2] reported that VCUG detection of urethrocele correlated directly with urinary stress incontinence. On the other hand, Greenwald et al [7] …”

Section: Discussionmentioning

confidence: 99%

Voiding cystourethrography in female stress incontinence.

Pelsang¹,

Bonney²

1996

American Journal of Roentgenology

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“…In previous studies, the posterior urethrovesical angle has been measured during straining by means of metallic bead-chain in the urethra [1][2][3], We did not have any 'instrument' in the urethra, and consequently the poste rior urethrovesical angle could only be measured when the urethra was filled with contrast. In the continent women this was only during micturition.…”

Section: Discussionmentioning

confidence: 99%

Dynamic Urethrocystography in Women

Westby¹,

Ulmsten²,

Asmussen³

1983

Urol Int

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A technique for video urethrocystography in women is described and evaluated from the results of examinations on 76 subjects. The patients were examined seated in the lateral position and investigations were carried out at rest, and during straining and coughing, micturition and holding-back maneuvers. Special attention was paid to the overall morphology and the position of the bladder base, the bladder neck and the urethra. Apart from the contour of the symphysis, which in some patients was difficult to identify, the various structures were easily displayed. Also the dynamics of the function of the bladder base, the bladder neck and the urethra were visualized. Almost all patients were able to carry out all parts of the examination including micturition without difficulty. TLD dosimeters in the vagina and uterus showed a low radiation dose to the ovaries.

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Section: Commentmentioning

confidence: 99%

“…The importance of urethral stabilization is supported by clinical studies showing that a widened posterior urethrovesical angle is associated with incontinence. [10][11][12] If these theories are correct, however, limiting the change in the posterior urethral angle caused by cough or Valsalva may be more indicative of urethral stabilization than is maintenance of an absolute value for the angle.The observed decrease in bladder neck funneling following pessary insertion may also be a function of stabilization of the proximal urethra. Funneling resolved in women in whom the pessary knob was at or below the bladder neck, possibly because stabilization of the posterior urethra allows forces applied superiorly and anteriorly to maintain apposition of the urethral walls.…”

mentioning

confidence: 99%

Restoration of continence by pessaries: magnetic resonance imaging assessment of mechanism of action

Komesu

Ketai

Rogers

et al. 2008

American Journal of Obstetrics and Gynecology

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OBJECTIVE-The objective of the study was to determine incontinence pessaries' mechanism of action by measuring changes on urodynamic studies (UDS) and dynamic magnetic resonance imaging (MRI) with and without pessaries in place.STUDY DESIGN-Women with stress incontinence had UDS and MRI performed with and without incontinence dish pessaries.RESULTS-Fifteen women were evaluated. Pessary insertion resulted in increased urethral resistance; detrusor pressures increased (33-45 cm H 2 O) and maximal flow rates decreased (30 to 19 mL/second). With Valsalva on MRI, pessaries were associated with decreased posterior urethrovesical angles (175-130°), bladder neck elevation (0.3 below to 0.8 cm above the pubococcygeal line) and increased urethral lengths (2.4 to 2.97 cm). Bladder neck funneling with cough occurred in 14 patients without pessaries and 3 with pessaries.CONCLUSION-On UDS and MRI following pessary placement, continence restoration was associated with decreased posterior urethrovesical angles, bladder neck descent and funneling, and increased urethral lengths and resistance to urine flow. Keywords magnetic resonance imaging; pessary; urinary incontinence; urodynamic studies Stress urinary incontinence (SUI), involuntary urine loss that occurs with increased intraabdominal pressure, 1 affects many women. A number of theories postulate why SUI occurs. Pessaries are among the few nonsurgical treatments of SUI. Pessary treatment is simple and can therefore serve as starting point in understanding the mechanisms underlying the restoration of continence.Current theories of continence include Enhorning's pressure transmission theory, the hammock hypothesis, and the integral theory. [2][3][4] Enhorning's theory postulates that the proximal urethra must be subject to intraabdominal pressure to close during cough or This study was presented at the 28th Annual Scientific Meeting of the American Urogynecologic Society, Hollywood, FL, Sept. 27-29, 2007. Reprints not available from the authors Valsalva, maintaining continence. 2 The hammock hypothesis proposes that structures posterior to the urethra form a back-stop. When intraabdominal pressure increases, the urethra is compressed against this supportive tissue and continence is maintained. 3 Supportive structures surrounding the urethra are also pivotal in preserving continence in the integral theory. 4 This theory proposes that musculoelastic properties of the vagina not only contribute to formation of a backstop posterior to the urethra but also result in lengthening of urethra, both components of continence. These theories are not mutually exclusive, and parts of 1 or more the theories may explain successful treatment of SUI. HHS Public AccessPessaries offer a unique approach to understanding continence mechanisms because they provide a readily reversible method of restoring continence. They allow the study of patients during periods of continence and incontinence that are separated in time by only minutes. Using both magnetic resonance imaging (MRI) and ur...

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Development of a plan for the diagnosis and treatment of urinary stress incontinence

Cited by 175 publications

References 5 publications

Voiding cystourethrography in female stress incontinence.

Voiding cystourethrography in female stress incontinence.

Dynamic Urethrocystography in Women

Restoration of continence by pessaries: magnetic resonance imaging assessment of mechanism of action

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