nach oben

International Urogynecology Journal

Erschienen in:

01.08.2012 | Original Article

Levator function and voluntary augmentation of maximum urethral closure pressure

verfasst von: Hans Peter Dietz, Ka Lai Shek

Erschienen in: International Urogynecology Journal | Ausgabe 8/2012

Einloggen, um Zugang zu erhalten

Abstract

Introduction and hypothesis

The aim of the study was to test whether women with symptoms of pelvic floor dysfunction can augment maximum urethral closure pressure (MUCP) with a pelvic floor muscle contraction (PFMC) and whether augmentation is associated with structure and function of the levator ani muscle.

Methods

Between January and December 2009, 300 women attended a tertiary referral service for multichannel urodynamic testing and 4D pelvic floor ultrasound. The MUCP was obtained with a perfused fluid-filled catheter. Augmented MUCPs were obtained during directed PFMC. Levator contraction strength was assessed digitally, using the Modified Oxford Grading (MOS). Levator integrity was determined using tomographic ultrasound, and we also measured dimensions of the levator hiatus at rest and on PFMC, blinded against all clinical data.

Results

The MUCP was measured at a mean of 36 cm H₂O (range 2–111). Augmented MUCP was 42 cm H₂O on average (4–125). Of those who attempted augmentation (n = 275), 80 produced a reduction in MUCP and were excluded, leaving 195. There was a significant correlation between MOS and augmentation (r = 0.24, P = 0.001). Women with an intact levator muscle were able to augment more effectively (P = 0.038).

Conclusions

Urethral closure pressure can be augmented voluntarily by symptomatic patients, on average by about 20 %. The degree of augmentation is positively associated with levator contractility as measured by digital palpation and negatively with levator avulsion.

Keane DP, O’Sullivan S (2000) Urinary incontinence: anatomy, physiology and pathophysiology. Baillieres Best Pract Res Clin Obstet Gynaecol 14(2):207–226PubMedCrossRef

Pirpiris A, Shek K, Kay P, Dietz H (2010) Urethral mobility and urinary incontinence. Ultrasound Obstet Gynecol 36:507–511PubMedCrossRef

Schäfer W (2001) Some biomechanical aspects of continence function. Scand J Urol Nephrol Suppl 207:44–60PubMed

Dietz HP, Erdmann M, Shek KL (2012) Reflex contraction of the levator ani and external perineal muscles in women symptomatic for pelvic floor disorders. Ultrasound Obstet Gynecol. doi:10.1002/uog.11087

Lovegrove Jones R, Peng Q, Stokes M, Humphrey V, Payne C, Constantinou C (2010) Mechanisms of pelvic floor muscle function and the effect on the urethra during a cough. Eur Urol 57(6):1101–1110PubMedCrossRef

Christensen LL, Djurhuus JC, Lewis MT, Dev P, Chase RA, Constantinou PS, Constantinou CE (1995) MRI of voluntary pelvic floor contraction in healthy female volunteers. Int Urogynecol J 6:138–152CrossRef

Constantinou C, Hvistendahl G, Ryhammer A, Nagel L, Djurhuus J (2002) Determining the displacement of the pelvic floor and pelvic organs during voluntary contractions using magnetic resonance imaging in younger and older women. BJU Int 90:408–414PubMedCrossRef

Peschers UM, Schaer GN, DeLancey JO, Schuessler B (1997) Levator ani function before and after childbirth. Br J Obstet Gynaecol 104(9):1004–1008PubMedCrossRef

Peschers UM, Vodušek DB, Fanger G, Schaer GN, DeLancey JO, Schuessler B (2001) Pelvic muscle activity in nulliparous volunteers. Neurourol Urodyn 20(3):269–275PubMedCrossRef

10.

Wilson PD, Hay Smith EJ, Nygaard IE, Wyman JF, Yamanishi T, Berghmans B, Hagen B, Sinclair L, Moore K (2005) Adult conservative management. In: Abrams P, Cardozo L, Khoury S, Wein A (eds) Third International Consultation on Incontinence. Health Publications, Paris, pp 855–964

11.

Baessler K, Miska K, Draths R, Schuessler B (1999) The effect of voluntary pelvic floor contraction and relaxation on the urethral closure pressure. Neurourol Urodyn 18(4):359–360

12.

van Loenen NT, Vierhout ME (1997) Augmentation of urethral pressure profile by voluntary pelvic floor contraction. Int Urogynecol J Pelvic Floor Dysfunct 8(5):284–287PubMedCrossRef

13.

Bø K, Talseth T (1997) Change in urethral pressure during voluntary pelvic floor muscle contraction and vaginal electrical stimulation. Int Urogynecol J Pelvic Floor Dysfunct 8(1):3–6; discussion 6–7PubMedCrossRef

14.

Dietz H (2010) Pelvic floor ultrasound: a review. Am J Obstet Gynecol 202:321–334PubMedCrossRef

15.

Laycock J (1994) Clinical evaluation of the pelvic floor. In: Schuessler B (ed) Pelvic floor re-education: principles and practice. Springer, London, pp 42–48

16.

Dietz HP, Shek C (2008) Levator avulsion and grading of pelvic floor muscle strength. Int Urogynecol J Pelvic Floor Dysfunct 19(5):633–636PubMedCrossRef

17.

Dietz H, Bernardo M, Kirby A, Shek K (2010) Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J 22(6):699–704PubMedCrossRef

18.

Dietz H, Abbu A, Shek K (2008) The levator-urethra gap measurement: a more objective means of determining levator avulsion? Ultrasound Obstet Gynecol 32:941–945PubMedCrossRef

19.

Dietz H, Shek K, Clarke B (2005) Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol 25:580–585PubMedCrossRef

20.

Yang J, Yang S, Huang W (2006) Biometry of the pubovisceral muscle and levator hiatus in nulliparous Chinese women. Ultrasound Obstet Gynecol 28:710–716PubMedCrossRef

21.

Majida M, Brækken IH, Umek W, Bø K, Šaltytė Benth J, Ellstrøm Engh M (2009) Interobserver repeatability of three- and four-dimensional transperineal ultrasound assessment of pelvic floor muscle anatomy and function. Ultrasound Obstet Gynecol 33(5):567–573PubMedCrossRef

22.

Kruger J, Heap X, Murphy B, Dietz H (2008) Pelvic floor function in nulliparous women using three-dimensional ultrasound and magnetic resonance imaging. Obstet Gynecol 111:631–638PubMedCrossRef

23.

Jung S, Pretorius D, Padda B, Weinstein M, Nager C, den Boer D, Mittal R (2007) Vaginal high-pressure zone assessed by dynamic 3-dimensional ultrasound images of the pelvic floor. Am J Obstet Gynecol 197(1):52.e1–52.e7CrossRef

24.

Bø K (2003) Pelvic floor muscle strength and response to pelvic floor muscle training for stress urinary incontinence. Neurourol Urodyn 22(7):654–658PubMedCrossRef

25.

Braekken I, Majida M, Engh M, Bø K (2010) Morphological changes after pelvic floor muscle training measured by 3-dimensional ultrasonography: a randomized controlled trial. Obstet Gynecol 115(2 Pt 1):317–324PubMedCrossRef

26.

Kenton K, Brubaker LP (2001) Relationship between levator ani contraction and motor unit activation in the urethral sphincter. Int Urogynecol J 12(S1):16

27.

Erdmann M, Shek KL, Dietz HP (2010) Does urethral mobility confound the relationship between urethral closure pressure and stress continence? Int Urogynecol J 21:S51–S53

28.

Dietz HP, Shek KL (2008) The quantification of levator muscle resting tone by digital assessment. Int Urogynecol J Pelvic Floor Dysfunct 19:1489–1493PubMedCrossRef

29.

Guaderrama N, Liu J, Nager C, Pretorius D, Sheean G, Kassab G, Mittal R (2005) Evidence for the innervation of pelvic floor muscles by the pudendal nerve. Obstet Gynecol 106(4):774–781PubMedCrossRef

30.

Dietz H, Lanzarone V (2005) Levator trauma after vaginal delivery. Obstet Gynecol 106:707–712PubMedCrossRef

31.

Morgan D, Cardoza P, Guire K, Fenner D, DeLancey J (2010) Levator ani defect status and lower urinary tract symptoms in women with pelvic organ prolapse. Int Urogynecol J 21(1):47–52PubMedCrossRef

32.

Dietz H, Kirby A, Shek K, Bedwell P (2009) Does avulsion of the puborectalis muscle affect bladder function? Int Urogynecol J Pelvic Floor Dysfunct 20:967–972PubMedCrossRef

33.

Dietz HP, Clarke B (2001) The urethral pressure profile and ultrasound imaging of the lower urinary tract. Int Urogynecol J Pelvic Floor Dysfunct 12(1):38–41PubMedCrossRef

34.

van Geelen JM (1994) Delivery and urethral sphincter incontinence. In: Schuessler B, Laycock J, Norton P, Stanton SL (eds) Pelvic floor re-education: principles and practice. Springer, London, pp 111–118

35.

Dietz H, Habtemariam T, Williams G (2011) Does obstructed labour lead to atrophy of the levator ani muscle? Neurourol Urodyn 30(6):1194–1195

36.

Shek K, Pirpiris A, Dietz H (2010) Does levator avulsion increase urethral mobility? Eur J Obstet Gynecol Reprod Biol 153:215–219PubMedCrossRef

Titel: Levator function and voluntary augmentation of maximum urethral closure pressure
verfasst von: Hans Peter Dietz
Ka Lai Shek
Publikationsdatum: 01.08.2012
Verlag: Springer-Verlag
Erschienen in: International Urogynecology Journal / Ausgabe 8/2012
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-012-1705-3

Neu im Fachgebiet Gynäkologie und Geburtshilfe

23.04.2024 | Medikamente in Schwangerschaft und Stillzeit | Nachrichten

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.

Newsletter bestellen

Springer Medizin

Levator function and voluntary augmentation of maximum urethral closure pressure

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie

Springer Medizin

Abstract

Introduction and hypothesis

Methods

Results

Conclusions

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 8/2012

The iceberg of health care utilization in women with urinary incontinence

Pathophysiology of overactive bladder

Symptoms, quality of life, and factors affecting women’s treatment decisions regarding pelvic organ prolapse

Low-frequency electrotherapy for female patients with detrusor underactivity due to neuromuscular deficiency

Variation of distances from mid-urethra to the obturator foramen: an MRI study

Cystoscopic removal of intravesical synthetic mesh extrusion with the aid of Endoloop sutures and endoscopic scissors

Neu im Fachgebiet Gynäkologie und Geburtshilfe

ICI-Therapie in der Schwangerschaft wird gut toleriert

Weniger postpartale Depressionen nach Esketamin-Einmalgabe

Bei RSV-Impfung vor 60. Lebensjahr über Off-Label-Gebrauch aufklären!

Harnwegsinfektprophylaxe: Es geht auch ohne Antibiotika

Update Gynäkologie