Basic science and translational research in female pelvic floor disorders: proceedings of an NIH-sponsored meeting

AIMS: To report the findings of a multidisciplinary group of scientists focusing on issues in basic science and translational research related to female pelvic floor disorders, and to produce recommendations for a research agenda for investigators studying female pelvic floor disorders. METHODS: A National Institutes of Health (NIH)-sponsored meeting was held on November 14-15, 2002, bringing together scientists in diverse fields including obstetrics, gynecology, urogynecology, urology, gastroenterology, biomechanical engineering, neuroscience, endocrinology, and molecular biology. Recent and ongoing studies were presented and discussed, key gaps in knowledge were identified, and recommendations were made for research that would have the highest impact in making advances in the field of female pelvic floor disorders. RESULTS: The meeting included presentations and discussion on the use of animal models to better understand physiology and pathophysiology; neuromuscular injury (such as at childbirth) as a possible pathogenetic factor and mechanisms for recovery of function after injury; the use of biomechanical concepts and imaging to better understand the relationship between structure and function; and molecular and biochemical mechanisms that may underlie the development of female pelvic floor disorders. CONCLUSIONS: While the findings of current research will help elucidate the pathophysiologic pathways leading to the development of female pelvic floor disorders, much more research is needed for full understanding that will result in better care for patients through specific rather than empiric therapy, and lead to the potential for prevention on primary and secondary levels.     

Ultrasound imaging of the pelvic floor: Where are we going?

We produced a non systematic review of ultrasound imaging of the pelvic floor in women with urinary incontinence (UI) and/or pelvic organ prolapse (POP). We have searched the PubMed and Embase databases for the following PICO question: women; imaging; urinary incontinence, pelvic organ prolapse, pelvic floor, pelvic floor muscle, pelvic floor muscle training; physical examination, no imaging; diagnosis, prognosis, outcome. The production of a systematic review was deemed impossible based on the type and quality of the published evidence. Clinical research focused on the pathophysiology of the UI and POP looking relation between anatomic abnormalities, childbirth, the risk of UI or POP, the outcome of conservative treatment and reconstructive surgery. Published papers fall into the remits of diagnostic studies but often fail to comply with the recommendations of the STARD initiative. Most published evidence remains the product of a single institution effort and confirmatory studies are rarely found. Imaging studies in patients with UI did not provide evidence of any clinical benefit in the management of patients. In patients with POP, interesting correlations have been identified such as between childbirth, dimension of levator hiatus, avulsion of levator ani and risk of prolapse, but the non clinical benefit of pelvic floor imaging could still not be identified. Research on pelvic floor imaging requires a coordinated, international, multicentre effort to improve internal and external validity of imaging techniques, confirm observations published by single institutions and provide health technology assessment of imaging in the management of UI or POP patients.     

Incidence of stress urinary incontinence following vaginal repair of pelvic organ prolapse in objectively continent women

Objective To estimate the incidence of stress urinary incontinence (SUI) following vaginal repair of pelvic organ prolapse (POP) in preoperatively continent women and to evaluate the impact of the problem. Methods Women were eligible if they had undergone vaginal repairs for any degree or type of POP with no anti‐incontinence procedure between July 1, 2004 and June 30, 2006, and had been continent preoperatively, as defined by a negative cough stress test with or without reduction of prolapse. Demographic, preoperative, operative, and postoperative data were retrieved from hospital charts. The incidence of postoperative SUI (POSUI) and its quality of life (QoL) impact were assessed by mailed questionnaire. The POSUI endpoint was defined by the report of SUI symptoms on the mailed questionnaire and/or affirmation of postoperative treatment for SUI. Results Forty‐two out of 100 respondents reported POSUI within the 2‐year average follow‐up period. Twelve of 37 symptomatic women (32%) were moderately or greatly bothered by their symptoms. The QoL impact score was generally low but was statistically greater in women with POSUI compared to those with no POSUI (13 vs. 3, P = 0.0006). Conclusion The risk of POSUI following vaginal repairs of POP may be higher than previously reported and approximately one‐third of women are bothered by these symptoms. These findings deserve further investigation. Neurourol. Urodynam. 30:390–394, 2011. © 2011 Wiley‐Liss, Inc.     

Role of perineal ultrasound in the evaluation of urinary stress incontinence and pelvic organ prolapse: a systematic review

AIMS: A review of the international literature on urogynecology was performed to focus on the actual role of perineal ultrasound. It is an increasingly used tool for the assessment of pelvic floor dysfunction and incontinence. In recent years ultrasound studies have predominated but there is little information on normal values and confusion on methodology and measurements. The aim of this study is to report the data available in the Literature about ultrasound as investigational evaluation helpful in diagnosing of urinary incontinence and urethral hypermobility, to document pelvic floor anatomy and to assess anatomic and functional changes after surgery. METHODS: A MEDLINE search was conducted using combinations of heading terms: perineal, ultrasound, pelvic floor, urinary incontinence, pelvic organ prolapse. RESULTS: Ultrasound has become an indispensable diagnostic procedure in urogynecology. Perineal, introital, and endoanal ultrasound are the most recommended techniques and the results comprise qualitative and quantitative findings. These are important for determining the localization of the bladder neck and vesico-urethral junction and also for pre- and postoperative comparisons, and moreover for clinical applications and scientific investigations. CONCLUSIONS: There are as yet little data and there is a need to find in the near future more standard and objective parameters for the diagnosis of urinary incontinence. They will be obtained by means of more accurate analysis and comparison of the parameters, leading to a more clinically useful diagnostic test and assuring reliable and reproducible results.