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• W2048897496 abstract "No AccessJournal of UrologyAdult Urology1 Jun 2008Stress Urinary Incontinence: Relative Importance of Urethral Support and Urethral Closure Pressureis accompanied byBladder Dysfunction in Rats With Metabolic Syndrome Induced by Long-Term Fructose Feeding John O.L. DeLancey, Elisa R. Trowbridge, Janis M. Miller, Daniel M. Morgan, Kenneth Guire, Dee E. Fenner, William J. Weadock, and James A. Ashton-Miller John O.L. DeLanceyJohn O.L. DeLancey Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Johnson & Johnson. More articles by this author , Elisa R. TrowbridgeElisa R. Trowbridge Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , Janis M. MillerJanis M. Miller School of Nursing, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , Daniel M. MorganDaniel M. Morgan Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , Kenneth GuireKenneth Guire Department of Biostatistics, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , Dee E. FennerDee E. Fenner Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , William J. WeadockWilliam J. Weadock Department of Radiology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author , and James A. Ashton-MillerJames A. Ashton-Miller Department of Mechanical Engineering, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Johnson & Johnson. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2008.01.098AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Treatment strategies for stress incontinence are based on the concept that urethral mobility is the predominant causal factor with sphincter function a secondary contributor. To our knowledge the relative importance of these 2 factors has not been assessed in properly controlled studies. Materials and Methods: The Research on Stress Incontinence Etiology project is a case-control study that compared 103 women with stress incontinence and 108 asymptomatic controls in groups matched for age, race, parity and hysterectomy. Urethral closure pressure, urethral and pelvic organ support, levator ani muscle function and intravesical pressure were measured and analyzed using logistic regression and multivariable modeling. Results: Mean ± SD maximal urethral closure pressure was 42% lower in cases (40.8 ± 17.1 vs 70.2 ± 22.4 cm H2O, d = 1.47). Lesser effect sizes were seen for support parameters, including resting urethral axis and urethrovaginal support (d = 0.41 and 0.50, respectively). Other pelvic floor parameters, including genital hiatus size and urethral axis during muscle contraction (d = 0.60 and 0.58, respectively), differed but levator strength and levator defect status did not. Maximum cough pressure, which is an assessment of stress on the continence mechanism, was also different (d = 0.43). After adjusting for body mass index the maximal urethral closure pressure alone correctly classified 50% of cases. Adding the best predictors for urethrovaginal support and cough strength to the model added 11% of predictive ability. Conclusions: The finding that maximal urethral closure pressure and not urethral support is the factor most strongly associated with stress incontinence implies that improving urethral function may have therapeutic promise. References 1 : Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol2006; 107: 1253. Google Scholar 2 : Annual direct cost of urinary incontinence. Obstet Gynecol2001; 98: 398. Google Scholar 3 : Epidemiology of incontinence in the county of Nord-Trondelag: A community-based epidemiological survey of female urinary incontinence: the Norwegian EPINCONT study. J Clin Epidemiol2000; 53: 1150. Google Scholar 4 : A prospective multicenter randomized trial of tension-free vaginal tape and colposuspension for primary urodynamic stress incontinence: two-year follow-up: UK and Ireland TVT Trial Group. Am J Obstet Gynecol2004; 190: 324. 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Am J Obstet Gynecol2002; 186: 356. Google Scholar 18 : Expression of nitric oxide synthase immunoreactivity in the human female intramural striated urethral sphincter. J Urol2003; 169: 2407. Link, Google Scholar 19 : Spontaneous activity of lower urinary tract smooth muscles: correlation between ion channels and tissue function. J Physiol2006; 570: 13. Google Scholar 20 : Vaginal birth and de novo stress incontinence; Relative contributions of urethral dysfunction and support loss. Obstet Gynecol2007; 110: 354. Google Scholar © 2008 by American Urological AssociationFiguresReferencesRelatedDetailsCited byElmelund M, Sokol E, Karram M, Dmochowski R and Klarskov N (2019) Patient Characteristics that May Influence the Effect of Urethral Injection Therapy for Female Stress Urinary IncontinenceJournal of Urology, VOL. 202, NO. 1, (125-131), Online publication date: 1-Jul-2019.Andreev V, Liu G, Yang C, Smith A, Helmuth M, Wiseman J, Merion R, Weinfurt K, Cameron A, Lai H, Cella D, Gillespie B, Helfand B, Griffith J, DeLancey J, Fraser M, Clemens J and Kirkali Z (2018) Symptom Based Clustering of Women in the LURN Observational Cohort StudyJournal of Urology, VOL. 200, NO. 6, (1323-1331), Online publication date: 1-Dec-2018.Atala A (2017) Re: Smooth Muscle Progenitor Cells Derived from Human Pluripotent Stem Cells Induce Histologic Changes in Injured Urethral SphincterJournal of Urology, VOL. 198, NO. 6, (1214-1214), Online publication date: 1-Dec-2017.Wein A (2013) Re: Maximum Urethral Closure Pressure in Women: Normative Data and Evaluation as a Diagnostic TestJournal of Urology, VOL. 190, NO. 1, (195-195), Online publication date: 1-Jul-2013.Stafford R, Ashton-Miller J, Constantinou C and Hodges P (2012) Novel Insight into the Dynamics of Male Pelvic Floor Contractions Through Transperineal Ultrasound ImagingJournal of Urology, VOL. 188, NO. 4, (1224-1230), Online publication date: 1-Oct-2012.Rajasekaran M, Sohn D, Salehi M, Bhargava V, Fritsch H and Mittal R (2012) Role of Puborectalis Muscle in the Genesis of Urethral PressureJournal of Urology, VOL. 188, NO. 4, (1382-1388), Online publication date: 1-Oct-2012.Shek K, Dietz H and Kirby A (2010) The Effect of Childbirth on Urethral Mobility: A Prospective Observational StudyJournal of Urology, VOL. 184, NO. 2, (629-634), Online publication date: 1-Aug-2010.Richter H, Kenton K, Huang L, Nygaard I, Kraus S, Whitcomb E, Chai T, Lemack G, Sirls L, Dandreo K and Stoddard A (2009) The Impact of Obesity on Urinary Incontinence Symptoms, Severity, Urodynamic Characteristics and Quality of LifeJournal of Urology, VOL. 183, NO. 2, (622-628), Online publication date: 1-Feb-2010.Morgan D, Umek W, Guire K, Morgan H, Garabrant A and DeLancey J (2009) Urethral Sphincter Morphology and Function With and Without Stress IncontinenceJournal of Urology, VOL. 182, NO. 1, (203-209), Online publication date: 1-Jul-2009.Related articlesJournal of Urology23 Apr 2008Bladder Dysfunction in Rats With Metabolic Syndrome Induced by Long-Term Fructose Feeding Volume 179Issue 6June 2008Page: 2286-2290 Advertisement Copyright & Permissions© 2008 by American Urological AssociationKeywordspelvic floorurodynamicsurethraurinary incontinence, stressfemaleMetricsAuthor Information John O.L. DeLancey Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Johnson & Johnson. More articles by this author Elisa R. Trowbridge Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author Janis M. Miller School of Nursing, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author Daniel M. Morgan Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author Kenneth Guire Department of Biostatistics, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author Dee E. Fenner Department of Obstetrics and Gynecology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author William J. Weadock Department of Radiology, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan More articles by this author James A. Ashton-Miller Department of Mechanical Engineering, Pelvic Floor Research Group, University of Michigan, Ann Arbor, Michigan Financial interest and/or other relationship with Johnson & Johnson. More articles by this author Expand All Advertisement PDF downloadLoading ..." @default.
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