PURPOSE: Stress urinary incontinence (SUI) is one of the most common lower urinary tract symptoms in women. We analyzed age-associated changes in urodynamic parameters in women with SUI. MATERIALS AND METHODS: We analyzed the urodynamic study (UDS) results of patients with urodynamically proven SUI between March 2008 and July 2014. In uroflowmetry, maximal flow rate (Qmax), time to Qmax, voided volume, and postvoid residual urine volume (PVR) and filling cystometry data including first, strong desire to void and Valsalva leak point pressure (VLPP) were measured. Also, Qmax and detrusor pressure at Qmax (Pdet@Qmax) of voiding cystometry data were analyzed. RESULTS: The subjects included 776 patients. Among the patients, 151 were withdrawn because of incomplete UDS data or because they met the exclusion criteria. A total of 625 patients enrolled in our study. The mean age of the population was 57.3 years. The mean Qmax, voided volume, voiding time, and PVR were 26.2 mL/s, 292.1 mL, 25.7 s, and 31.7 mL, respectively. Qmax (p=0.001) in uroflowmetry, PVR (p=0.042), first desire to void (p=0.042), Pdet@Qmax (p=0.016), and the bladder contractility index (p=0.046) were significantly different between the age groups. Qmax and Pdet@Qmax were decreased and PVR was increased significantly with age after 60 years. CONCLUSIONS: Older women with SUI also have worsened voiding function with age as the results of urodynamic parameters. Specifically, detrusor contractility decreased with age after 60 years.
Aged ; *Aging ; Female ; Humans ; Middle Aged ; Urinary Bladder/*physiopathology ; Urinary Incontinence, Stress/*physiopathology ; *Urodynamics

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p>0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p>0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise.
Activities of Daily Living ; Biofeedback (Psychology)* ; Exercise Therapy*/methods ; Female ; Human ; Muscle Contraction ; Muscles ; Pelvic Floor ; Treatment Outcome ; Urinary Incontinence, Stress/therapy* ; Urinary Incontinence, Stress/psychology ; Urinary Incontinence, Stress/prevention & control ; Urinary Incontinence, Stress/physiopathology

We undertook this work to compare the treatment efficacies and the changes of quality of life after pelvic floor muscle (PFM) exercise and the functional electrical stimulation (FES)-biofeedback treatment, both of which are being widely used as conservative treatment methods for female urinary incontinence. We randomly selected 60 female incontinence patients who visited our department and divided them evenly into two groups. They were treated for a period of 6 weeks. The subjective changes in the severity of incontinence and discomfort in daily and social life were measured using a translated version of the questionnaire by Jackson. Objective changes of pelvic muscle contraction force were measured using a perineometer. Pre- and post-treatment maximal pelvic floor muscle contractile (PMC) pressure and changes in the severity of urinary incontinence and discomfort of the two groups showed statistically significant differences (p>0.001). In particular the FES-biofeedback group showed significantly increased maximal PMC pressure and a decreased severity of urinary incontinence and discomfort compared to the intensive PFM exercise group (p>0.001). In conclusion, FES-biofeedback proved more effective than simple PFM exercise.
Activities of Daily Living ; Biofeedback (Psychology)* ; Exercise Therapy*/methods ; Female ; Human ; Muscle Contraction ; Muscles ; Pelvic Floor ; Treatment Outcome ; Urinary Incontinence, Stress/therapy* ; Urinary Incontinence, Stress/psychology ; Urinary Incontinence, Stress/prevention & control ; Urinary Incontinence, Stress/physiopathology

OBJECTIVETo verify the effect of electroacupuncture (EA) for female stress urinary incontinence (SU).

METHODSForty-two patients were randomly divided into an observation group(20 cases) and a control group (22 cases). EA at Zhongliao (BL 33) and Huiyang (BL 35) was used in the observation group. Sham acupuncture at non meridian points, one can beside Zhongliao (BL 33) and Huiyang (BL 35), was applied, and placebo EA was adopted in the control group. Treatment with needle retained for 30 min a time was given once every other day and three times a week for continuous six weeks in the two groups. Urinary and reproductive simple score (UDI),visual analogue scale (VAS) and the frequency of nocturnal enuresis were observed before treatment, at the second, forth and sixth week of treatment in the two groups, and the efficacy was compared.

RESULTSThe effective rates of the observation group were 80.0% (16/20), 95.0% (19/20) and 95.0% (19/20), which were better than 40.9% (9/22), 31.8% (7/22) and 27.3% (6/22) of the control group at the second, forth and sixth week of treatment. The differences were statistically significant between the two groups (all P < 0.05). After treatment in the observation group, the results of UDI, VAS and frequency of nocturnal enuresis were improved compared with those before treatment (all P < 0.05). Along with treatment, all indices were gradually improved, and the change at the sixth week was the most obvious in observation group. The results of the observation group were better than those of the control group at all times (all P < 0.05).

CONCLUSIONEA achieves obvious effect for female SUI, and effectively improves the lower urinary trace symptoms, the degree of urinary incontinence and the frequency of nocturnal enuresis. The effect becomes increasingly better along with treatment within six weeks.

Acupuncture Points ; Electroacupuncture ; Female ; Humans ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy ; Urination

Acupuncture Therapy ; Female ; Humans ; Middle Aged ; Urinary Incontinence, Stress ; physiopathology ; therapy ; Urination

BACKGROUNDOccult stress urinary incontinence may lead to de novo stress urinary incontinence after pelvic floor repair surgery. A measurement of pudendal nerve terminal motor latency can reflect the integrity of the nerves. We aimed to explore the value of pudendal nerve terminal motor latency in the diagnosis of occult stress urinary incontinence in pelvic organ prolapse patients.

METHODSTen patients with stress urinary incontinence (SUI group), 10 with SUI and uterine or vaginal prolapse (POP + SUI group) and 10 with uncomplicated uterine or vaginal prolapse (POP group) were evaluated for their pudendal nerve terminal motor latency using a keypoint electromyogram.

RESULTSThe amplitude of positive waves was between 0.1 and 0.2 mV. The nerve terminal motor latency was between 1.44 and 2.38 ms. There was no significant difference in the wave amplitudes of pudendal nerve evoked action potential among the three different groups (P > 0.05). The pudendal nerve latency of the SUI group, POP + SUI group and POP group were (2.9 ± 0.7) seconds, (2.8 ± 0.7) seconds and (1.9 ± 0.5) seconds respectively. The difference between the SUI group and POP + SUI group was not statistically significant (P > 0.05), whereas the difference between the SUI and POP groups and between the POP + SUI and POP groups were statistically significant (P < 0.05). There was a positive correlation between pudendal nerve latency and the severity of SUI; the correlation coefficient was 0.720 (P < 0.01).

CONCLUSIONSPatients with SUI may have some nerve demyelination injuries in the pudendal nerve but the damage might not involve the nerve axons. The measurement of pudendal nerve latency may be useful for the diagnosis of SUI in POP patients.

Evoked Potentials ; physiology ; Female ; Humans ; Middle Aged ; Pelvic Organ Prolapse ; physiopathology ; Pudendal Nerve ; physiopathology ; Urinary Incontinence, Stress ; diagnosis ; physiopathology ; Uterine Prolapse ; physiopathology

OBJECTIVETo compare the difference in the clinical efficacy on mild and moderate female stress urinary incontinence (FSUI) between transcutaneous acupoint electrical stimulation and oral administration of midodrine hydrochloride tablets.

METHODSNinety cases of mild and moderate FSUI were randomized into an observation group and a control group, 45 cases in each one. In the observation group, the transcutaneous acupoint electrical stimulation was applied to Ciliao (BL 32), Shenshu (BL 23), Zigong (EX-CA 1), Guanyuan (CV 4) and Qihai (CV 6), once a day. In the control group, midodrine hydrochloride tablets were prescribed for oral administration, 2. 5 mg per treatment, three times each day. The duration of treatment was 4 weeks. The score of international consultation on incontinence questionnaire-urinary incontinence short form (ICI-Q-SF) and leakage of urine in 1 h urinal pad test were observed before and after treatment in the patients of the two groups, and the efficacy was compared between the two groups.

RESULTSThe score of ICI-Q-SF and leakage of urine in urinal pad test after treatment were all improved apparently as compared with those before treatment in the two groups (all P<0. 01), and the results in the observation group were better than those in the control group (both P<0. 01). The total effective rate was 86. 7% (39/45) in the observation group, which was better than 68. 9% (31/45, P<0. 05) in the control group.

CONCLUSIONThe transcutaneous acupoint electrical stimulation achieves the better efficacy on FSUI as compared with the oral administration of midodrine hydrochloride tablets. This therapy effectively improves the patient's urine control ability and reduces leakage of urine.

Acupuncture Points ; Adult ; Female ; Humans ; Middle Aged ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy

PURPOSE: We assessed the impact of transobturator tape (TOT) treatment on overactive bladder (OAB) symptoms with a particular focus on nocturia in patients with mixed urinary incontinence (MUI). MATERIALS AND METHODS: In this retrospective cohort study, the medical records of 237 women who underwent TOT surgery for the treatment of MUI were reviewed. Of these, 86 patients (36.4%) had preoperative nocturia. Patients with neurological diseases or sleep disorders that could affect the voiding pattern were excluded. Patients who were being treated with anticholinergics and antidiuretic hormones were also excluded, which left 70 subjects eligible for analysis. Pre- and postoperative evaluations consisted of a physical examination, 3-day frequency-volume chart, and health-related quality of life questionnaires (King's health questionnaire, overactive bladder symptom score, and OAB-questionnaire). RESULTS: TOT treatment resulted in an overall significant improvement in OAB symptoms including nocturia. Frequency-volume charts revealed that TOT treatment significantly decreased the actual number of nightly voids (ANV) and the nocturnal bladder capacity index (NBCi) in the entire cohort. However, in a subgroup of women with nocturnal polyuria, there was no significant change in ANV or NBCi after the sling operation. Correlation analysis of the whole cohort revealed that the postoperative changes in NBCi correlated positively with postoperative changes in ANV. The nocturia-persisting group was more likely to have nocturnal polyuria and lower preoperative functional bladder capacity compared with the nocturia-improved group (p=0.024 and p=0.023, respectively). CONCLUSIONS: Our results demonstrated that the TOT procedure resulted in an overall significant improvement in OAB symptoms including OAB-related nocturia in patients who presented with MUI.
Adult ; Aged ; Female ; Humans ; Middle Aged ; Nocturia/physiopathology/*surgery ; Retrospective Studies ; Severity of Illness Index ; *Suburethral Slings ; Treatment Outcome ; Urinary Bladder/physiopathology ; Urinary Bladder, Overactive/physiopathology/*surgery ; Urinary Incontinence, Stress/physiopathology/*surgery ; Urodynamics/physiology

MUCP (Maximal urethral closure pressure) is known to be increased in patients with vaginal wall prolapse due to the mechanical obstruction of the urethra. However, urethral function following reduction has not yet been completely elucidated. Predicting postoperative urethral function may provide patients with important, additional information prior to surgery. Thus, this study was performed to evaluate the relationship between MUCP and functional urethral length (FUL) according to stage and age in anterior vaginal wall prolapse patients. 139 patients diagnosed with anterior vaginal wall prolapse at Yonsei University Medical College (YUMC) from March 1999 to May 2003 who had underwent urethral pressure profilometry following reduction were included in this study. The stage of pelvic organ prolapse (POP) was determined according to the dependent portion of the anterior vaginal wall (Aa, Ba). (By International Continence Society's POP Quantification system) Patients were divided into one of four age groups: patients in their 40s (n=13), 50s (n=53), 60s (n=54), and 70 and over (n=16). No difference in MUCP was found between the age groups. The FUL of patients in their 40s was shorter than that of patient's in their 50s and 60s. Patients were also divided into stages: stage II (n=35), stage III (n=76), and stage IV (n=25). No significant difference in MUCP was found according to stage and FUL. However, a significant difference was noted between stage III and IV as stage IV was longer. Anterior vaginal wall prolapse is known to affect urethral function due to prolapse itself, but according to our study, prolapse itself did not alter urethral function. This suggests that, regardless of age and stage, prolapse corrective surgery does not affect the urethral function.
Adult ; Age Factors ; Aged ; Female ; Humans ; Middle Aged ; Postoperative Complications ; Pressure ; Urethra/*anatomy & histology/*physiology ; Urinary Incontinence, Stress/etiology/physiopathology ; Uterine Prolapse/pathology/*physiopathology/*surgery

OBJECTIVETo observe the clinical effect of dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises for treatment of female stress urinary incontinence.

METHODSSeventy one cases were randomly divided into two groups. Thirty six cases in the observation group were treated with acupuncture on Zhongji (CV 3), Zigong (EX-CA 1), Chize (LU 5) etc. and tortoise-shell moxibustion on Shenque (CV 8) combined with pelvic floor muscle exercises; while thirty five cases in the control group were treated with only pelvic floor muscle exercises. The scores of the International Consultation Committee on Incontinence Questionnaire Short Form (ICI-Q-SF) and the Medical Outcomes Survey Short Form-36 (SF-36) were evaluated before and after treatment, and the scores of SF-36 were also compared with 35 cases in normal group.

RESULTSThe total effective rate of 91.7% in the observation group was higher than that of 77.1% in the control group (P < 0.05). The dimensions of SF-36 of stress urinary incontinence patients were remarkably lower than those of normal group (all P < 0.05). The scores of ICI-Q-SF were decreased while the scores of SF-36 were increased obviously after treatment in both the observation group and the control group, there were pronounced improvements on physiological function, pain, physical activity, social function and affection function in the observation group (all P < 0.05).

CONCLUSIONThe quality of life for female stress urinary incontinence patients may be poor, however the dog-day acupuncture and tortoise-shell moxibustion combined with pelvic floor muscle exercises can improve the symptoms of urinary incontinence and increase the quality of life of patients.

Acupuncture Therapy ; Adult ; Aged ; Exercise Therapy ; Female ; Humans ; Middle Aged ; Moxibustion ; Muscle Contraction ; Muscles ; physiopathology ; Treatment Outcome ; Urinary Incontinence, Stress ; physiopathology ; therapy