Morphology and neuropathology of the pelvic floor in patients with stress incontinence

Abstract

Urinary incontinence imposes a considerable workload on urological and gynecological practice. Many treatments exist, but recurrent stress incontinence remains a significant problem and the reasons remain unclear. Pathological and electrophysiological studies have shown that significant pelvic nerve damage and consequent denervation and reinnervation are associated with stress incontinence, and furthermore there are collagenous changes in the pelvic floor which are related to childbirth, endogenous hormone changes and the effects of increasing age. These changes include increased nerve fiber density and pudendal nerve terminal motor latency, hypertrophy of fiber types 1 and 2, type 1 fiber predominance and fiber type grouping. Connective tissue changes involve a reduction in hydroxyproline excretion, increased cross-linking and increased muscle collagen. It is only through a better understanding of the anatomy and pathophysiology of the pelvic floor that we will be able to improve outcome in women with stress incontinence and identify patients that may not be appropriate for surgical therapy. This paper reviews recent advances in the understanding of the etiology of stress incontinence.

Urinary incontinence: prevalence, risk factors, impact on quality of life and treatment seeking behaviour among middle aged women

“…More than two children, first child bearing age of less than 18, prolonged labor, vaginal deliveries and forceps deliveries, all contribute to the occurrence of urinary incontinence later in life. 16 The relationship between occurrence of urinary incontinence and chronic cough and chronic constipation can be explained by increased abdominal pressure in these conditions. 17 There was a significant association between urinary tract infection and urgency incontinence.…”

De novo urge syndrome and detrusor instability after anti-incontinence surgery: Current concepts, evaluation, and treatment

“…This finding correlates with morphometric studies showing and confirming the presence of detrusor denervation [30]. Patients with SUI have been shown to have morphologic and neuropathologic evidence of pelvic floor damage and denervation [31]. This may be worsened following surgery.…”

“…Patients with SUI are known to have alterations in connective tissue integrity and an impaired ability to synthesize type-I collagen [42,43]. In addition, these patients have been shown to have morphologic and neuropathologic evidence of pelvic floor damage and denervation [31]. It makes logical sense that in the process of correcting incontinence, creation of significant iatrogenic tissue injury may lead to further denervation and compromise of anatomic support, predisposing the patient to bladder and urethral dysfunction as well as prolapse formation.…”

Alterações da matriz extracelular causadas pelo diabetes: o impacto sobre a continência urinária

“…Todos esses autores concluíram que o colágeno tem importante papel na manutenção da continência urinária, porém o mecanismo envolvido ainda não está claro. Por outro lado, muitos autores relacionam a IU com aumento na quantidade de colágeno periuretral em mulheres [30][31][32] . Em 1998, Falconer et al 32 verificaram, em biópsia uretral, que a concentração de colágeno e o diâmetro das fibrilas colágenas eram 30% maior no grupo de mulheres incontinentes e concluíram que a IU está associada com mudanças no metabolismo do colágeno, levando ao aumento na sua concentração e no tamanho de suas fibras.…”