Quantification of intramuscular nerves within the female striated urogenital sphincter muscle*1

Pandit, Meghana M.; DeLancey, John O.L.; Ashton‐Miller, James A.; Iyengar, Jyothsna; BLAIVAS, MILA; Perucchini, Daniele

doi:10.1016/s0029-7844(00)00825-5

Cited by 46 publications

(7 citation statements)

References 7 publications

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“…Similar to our findings, prior urodynamic studies consistently report decreases in urethral closure pressures in continent women with advancing age(12, 13). Our urethral EMG data, which show MUP changes consistent with neuropathy not myopathy, support that the histologic findings of decreased muscle are likely secondary to neuromuscular decline rather than primary muscle pathology(14, 15). …”

Section: Discussionsupporting

confidence: 71%

Neuromuscular Characterization of the Urethra in Continent Women

Kenton

Brubaker

2011

Female Pelvic Medicine &Amp; Reconstructive Surgery

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Objectives To describe quantitative urethral function parameters in a racially diverse group of continent women. Materials and Methods Following Institutional Review Board approval, we recruited women without urinary incontinence from the community. To be considered continent, participants answered “never” to the first six questions on the stress subscale of the Medical, Epidemiologic, and Social Aspects of Aging urinary incontinence (MESA) questionnaire. Participants all underwent quantitative concentric urethral electromyography (EMG) and urodynamic testing (UDS). Results Thirty-one women with a mean±SD age of 39±14 years underwent EMG and UDS. The cohort was racially diverse with 13 Caucasians (43%), 13 African Americans (43%), and 4 Hispanics (14%). Body mass index (BMI) (P=.12, .06), age (P=.40, .64), and vaginal parity (P=.53, .76) did not differ by race or ethnicity. We did not detect differences in any EMG parameter by race, ethnicity or vaginally parity. A mean (range) of 30 motor unit action potential analysis (MUP) (10-55) were identified and analyzed in Multi-MUP analysis and 14 (8-21) were identified and analyzed in IP analysis. On average, 37±20% MUPs were polyphasic. Age significantly correlated with several measures of urethral sphincter function. Increasing age was inversely correlated with interference analysis (IP) turns (−.57, p=.001), IP amplitude (r=−.43, p=.02), IP turns/amplitude (r=−.54, p=.003), maximum urethral closure pressures (MUCP) (r=−.41, p=.04). Similarly, MUCP correlated with IP amplitude (r=.38, p=.04). Conclusions This urethral neuromuscular function data on the largest cohort of continent women fully characterized with quantitative urethral EMG demonstrates significant neuropathic MUP changes with advancing age.

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Section: Discussionsupporting

confidence: 71%

Neuromuscular Characterization of the Urethra in Continent Women

Kenton

Brubaker

2011

Female Pelvic Medicine &Amp; Reconstructive Surgery

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“…They suggest that loss of muscle fibers with aging is consistent with the hypothesis that muscle loss is a result of neural injury but conclude that the way nerve injury would affect urethral function remains unclear. Our urethral EMG data, which show MUP changes consistent with neuropathy not myopathy, support that the histologic findings of decreased muscle are likely secondary to neuromuscular decline rather than primary muscle pathology [21, 22]. …”

Section: Discussionsupporting

confidence: 68%

“…Older women demonstrated decreased MUP recruitment as measured by decreasing numbers of turns and lower turns/amplitude ratio. This relationship between age and urethral function is consistent with urodynamic measures of urethral function, histologic studies, and clinical rates of stress incontinence [6, 19–21]. Urodynamic studies consistently report decreases in urethral closure pressures in continent women with advancing age [19, 20].…”

Section: Discussionsupporting

confidence: 66%

Continent women have better urethral neuromuscular function than those with stress incontinence

Kenton¹,

Brubaker

2011

Int Urogynecol J

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Introduction and hypothesis The objective of this study is to describe urethral neuromuscular function using concentric needle electromyography (EMG) in stress incontinent (SUI) and asymptomatic women. Methods Following Institutional Review Board approval, we recruited SUI and asymptomatic women without urinary incontinence. Participants underwent quantitative urethral EMG and urodynamic testing. Results Sixty-seven women (37 SUI, 30 continent) with mean±SD age of 44±12 years participated. Nearly all EMG parameters showed significant differences between continent and SUI women consistent with better motor unit recruitment in continent women. Continent women had larger-amplitude, longer-duration motor unit action potentials (MUP) with increased turns and better MUP recruitment during bladder filling (P<.05). Increasing age was inversely correlated with nearly all MUP parameters (P<.05), suggesting MUP to be consistent with neuropathy. Conclusions We found significant differences in multiple MUP parameters in urethral sphincter between continent and stress incontinent women, suggesting continent women have better urethral innervation. We also found significant neuropathic MUP changes with advancing age, regardless of continence status.

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“…Multiparous women also showed higher age, larger numbers of pregnancies, and a higher prevalence of prior miscarriages/abortions than did nulliparous women in our study, which might explain why multiparous women were more susceptible to UI and pelvic floor changes than nulliparous women. The previous studies reported that higher age leads to the loss of nerve function and a decrease in the total number of striated muscle fibers of the urethral sphincter at a rate of 2% per year and a gradual decline in the maximum urethral closure pressure of approximately 15% per decade ( Pandit et al, 2000 ; Wesnes & Lose, 2013 ). A previous study demonstrated that pregnancy itself has an effect on the pelvic floor ( Dietz et al, 2004 ); the mechanical and hormonal effects of pregnancy can lead to biomechanical, neurological, or neuromuscular changes to the pelvic floor and pelvic organ support ( South et al, 2009 ; Chen et al, 2005 ), which may lead to more obvious BN mobility and contribute to pelvic floor dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women

Luo

Chen

et al. 2017

PeerJ

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BackgroundThis study was performed to compare changes in urinary incontinence (UI) symptoms and pelvic floor structure during pregnancy between nulliparous and multiparous women.MethodsA cross-sectional survey was performed among pregnant women from July 2016 to January 2017. In total, 358 pregnant women from two hospitals underwent an interview and pelvic floor transperineal ultrasound assessment. A questionnaire regarding sociodemographic, gynecological, obstetric features and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) were used for the interview. Imaging data sets were analyzed offline to assess the bladder neck vertical position (BNVP), urethral angles (α, β, and γ angles), and hiatal area (HA) at rest and at maximal Valsalva maneuver (VM).ResultsAfter excluding 16 women with invalid data, 342 women were included. The prevalence (χ2 = 9.15, P = 0.002), frequency (t = 2.52, P = 0.014), usual amount of UI (t = 2.23, P = 0.029) and scores of interference with daily life (t = 2.03, P = 0.045) during pregnancy were higher in multiparous than nulliparous women. A larger bladder neck descent (BND) (F = 4.398, P < 0.001), HA (F = 6.977, P < 0.001), α angle (F = 2.178, P = 0.030), β angle (F = 4.404, P < 0.001), and γ angle (F = 2.54, P = 0.011) at VM were discovered in pregnant women with UI than without UI. Multiparous women had a significantly higher BND (t = 2.269, P = 0.024) and a larger α angle (F = 2.894, P = 0.004), β angle (F = 2.473, P = 0.014), and γ angle (F = 3.255, P = 0.001) at VM than did nulliparous women.ConclusionMultiparous women experienced more obvious UI symptoms and pelvic floor structure changes during pregnancy than did nulliparous women.

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Quantification of intramuscular nerves within the female striated urogenital sphincter muscle*1

Abstract: Remarkable variation in the quantity of intramuscular nerves was found. Women with sparse intramuscular nerves had fewer striated muscle cells. Intramuscular nerve density declined with age.

Cited by 46 publications

References 7 publications

Neuromuscular Characterization of the Urethra in Continent Women

Neuromuscular Characterization of the Urethra in Continent Women

Continent women have better urethral neuromuscular function than those with stress incontinence

Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women

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