Hann-Chorng Kuo1. 1. Department of Urology, Buddhist Tzu Chi General Hospital, Hualien, Taiwan.
Abstract
BACKGROUND AND PURPOSE: The mechanism by which clinical improvement occurs through pelvic floor muscle training (PFMT) for genuine stress incontinence, detrusor instability, or mixed incontinence is not established. Videourodynamic assessment of the anatomical changes of the pelvic floor muscles has not been reported. This study investigated the anatomical change of bladder base descent as well as the functional changes of bladder and urethra after PFMT using videourodynamic study. METHODS: Forty women aged 35 to 67 years (median 45 years) with stress urinary incontinence (SUI) with or without urgency incontinence were enrolled in a PFMT program consisting of a structured 12-week treatment course. Videourodynamic study, urethral pressure profilometry (UPP), and abdominal leak point pressure study were performed at baseline and after PFMT. Videourodynamic changes and UPP results were also compared between patients with successful treatment and those with treatment failure. RESULTS: Treatment was successful in 22 patients (55%) and failed in 18 patients. After PFMT, the volume at bladder sensation and the cystometric capacity increased significantly in patients with successful treatment. In all patients, the mean bladder neck descent was significantly reduced during stress compared with that at rest. When pelvic floor contractions were performed voluntarily, the bladder neck elevation was significantly greater after PFMT than at baseline. Patients with successful treatment had a significantly greater bladder neck elevation and pelvic floor contraction pressure both before and after PFMT compared to patients who failed treatment. No significant difference was found in UPP parameters such as maximal urethral closure pressure, functional profile length, or pressure transmission ratio. CONCLUSIONS: The results of this study indicate that pelvic floor muscles can be strengthened by PFMT in about one-half of women with SUI as shown by the increased bladder neck elevation during voluntary pelvic floor contraction in videourodynamic study and increased pelvic floor contraction pressure in dynamic UPP study.
BACKGROUND AND PURPOSE: The mechanism by which clinical improvement occurs through pelvic floor muscle training (PFMT) for genuine stress incontinence, detrusor instability, or mixed incontinence is not established. Videourodynamic assessment of the anatomical changes of the pelvic floor muscles has not been reported. This study investigated the anatomical change of bladder base descent as well as the functional changes of bladder and urethra after PFMT using videourodynamic study. METHODS: Forty women aged 35 to 67 years (median 45 years) with stress urinary incontinence (SUI) with or without urgency incontinence were enrolled in a PFMT program consisting of a structured 12-week treatment course. Videourodynamic study, urethral pressure profilometry (UPP), and abdominal leak point pressure study were performed at baseline and after PFMT. Videourodynamic changes and UPP results were also compared between patients with successful treatment and those with treatment failure. RESULTS: Treatment was successful in 22 patients (55%) and failed in 18 patients. After PFMT, the volume at bladder sensation and the cystometric capacity increased significantly in patients with successful treatment. In all patients, the mean bladder neck descent was significantly reduced during stress compared with that at rest. When pelvic floor contractions were performed voluntarily, the bladder neck elevation was significantly greater after PFMT than at baseline. Patients with successful treatment had a significantly greater bladder neck elevation and pelvic floor contraction pressure both before and after PFMT compared to patients who failed treatment. No significant difference was found in UPP parameters such as maximal urethral closure pressure, functional profile length, or pressure transmission ratio. CONCLUSIONS: The results of this study indicate that pelvic floor muscles can be strengthened by PFMT in about one-half of women with SUI as shown by the increased bladder neck elevation during voluntary pelvic floor contraction in videourodynamic study and increased pelvic floor contraction pressure in dynamic UPP study.