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International Urogynecology Journal

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Open Access 08.01.2021 | Review Article

The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

verfasst von: Kobra Falah-Hassani, Joanna Reeves, Rahman Shiri, Duane Hickling, Linda McLean

Erschienen in: International Urogynecology Journal | Ausgabe 3/2021

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Abstract

Introduction and hypothesis

To evaluate the evidence for pathologies underlying stress urinary incontinence (SUI) in women.

Methods

For the data sources, a structured search of the peer-reviewed literature (English language; 1960–April 2020) was conducted using predefined key terms in PubMed and Embase. Google Scholar was also searched. Peer-reviewed manuscripts that reported on anatomical, physiological or functional differences between females with signs and/or symptoms consistent with SUI and a concurrently recruited control group of continent females without any substantive urogynecological symptoms. Of 4629 publications screened, 84 met the inclusion criteria and were retained, among which 24 were included in meta-analyses.

Results

Selection bias was moderate to high; < 25% of studies controlled for major confounding variables for SUI (e.g., age, BMI and parity). There was a lack of standardization of methods among studies, and several measurement issues were identified. Results were synthesized qualitatively, and, where possible, random-effects meta-analyses were conducted. Deficits in urethral and bladder neck structure and support, neuromuscular and mechanical function of the striated urethral sphincter (SUS) and levator ani muscles all appear to be associated with SUI. Meta-analyses showed that observed bladder neck dilation and lower functional urethral length, bladder neck support and maximum urethral closure pressures are strong characteristic signs of SUI.

Conclusion

The pathology of SUI is multifactorial, with strong evidence pointing to bladder neck and urethral incompetence. While there is also evidence of impaired urethral support and levator ani function, standardized approaches to measurement are needed to generate higher levels of evidence.

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These supportive tissues are often referred to as the “pubo-urethral ligaments,” although they do not insert exclusively into the pubic bone or attach directly to the urethra [139].

Rotational angle of the bladder neck was defined as the angle between lines from the symphysis pubis to the bladder neck [14, 90], as the difference between two angles formed by the intersection of a line from the symphysis pubis to the urethra and the sympysis pubis to the bladder neck [87] at rest and during straining, respectively.

Sliding was described as the difference between the urethra-bladder neck distance (the distance from the crossing point of the symphysis axis with the urethra to the bladder neck) at rest compared to on straining [87].

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Titel: The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis
verfasst von: Kobra Falah-Hassani
Joanna Reeves
Rahman Shiri
Duane Hickling
Linda McLean
Publikationsdatum: 08.01.2021
Verlag: Springer International Publishing
Erschienen in: International Urogynecology Journal / Ausgabe 3/2021
Print ISSN: 0937-3462
Elektronische ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-020-04622-9

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The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis

Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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Die Highlights vom Kongress des American College of Cardiology 2024

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Abstract

Introduction and hypothesis

Methods

Results

Conclusion

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