Marie-Claude Lemieux

Physiotherapy for persistent postnatal stress urinary incontinence: a randomized controlled trial.

OBJECTIVE: The aim of this study was to compare the effectiveness of multimodal supervised physiotherapy programs with the absence of treatment among women with persistent postnatal stress urinary incontinence. METHODS: This was a single-blind randomized controlled trial. Sixty-four women with stress urinary incontinence were randomly assigned to 8 weeks of either multimodal pelvic floor rehabilitation (n = 21), multimodal pelvic floor rehabilitation with abdominal muscle training (n = 23), or control non–pelvic floor rehabilitation (n = 20). The primary outcome measure consisted of a modified 20-minute pad test. The secondary outcome measures included a Visual Analog Scale describing the perceived burden of incontinence, the Urogenital Distress Inventory, the Incontinence Impact Questionnaire, and pelvic floor muscle function measurements. RESULTS: Two patients dropped out, leaving 62 for analysis. At follow-up, more than 70% of the women in the treatment groups (14/20 in the pelvic floor and 17/23 in the pelvic floor plus abdominal group) were continent on pad testing compared with 0% of women in the control group. Scores on the pad test, Visual Analog Scale, Urogenital Distress Inventory, and Incontinence Impact Questionnaire improved significantly in both treatment groups (all P < .002), whereas no changes were observed in the control group. Pelvic floor muscle function, however, did not improve significantly in either active group. CONCLUSION: Multimodal supervised pelvic floor physiotherapy is an effective treatment for persistent postnatal stress urinary incontinence. LEVEL OF EVIDENCE: I

Severe soft tissue infection of the thigh after vaginal erosion of transobturator tape for stress urinary incontinence

Since the beginning of use of synthetic midurethral slings, several complications, usually benign, have been reported. Recently, three consecutive cases of severe thigh infection secondary to transobturator insertion of a synthetic tape alarmed us. This is a case report about these three cases and a review of literature about complications of transobturator tapes.

Responsiveness and Clinical Utility of the Geriatric Self‐Efficacy Index for Urinary Incontinence

OBJECTIVES: To report on the responsiveness testing and clinical utility of the 12‐item Geriatric Self‐Efficacy Index for Urinary Incontinence (GSE‐UI).

Creation and Testing of the Geriatric Self‐Efficacy Index for Urinary Incontinence

OBJECTIVES: To report on the content development, construct validity, and reliability testing of the Geriatric Self‐Efficacy Index for Urinary Incontinence (GSE‐UI).

Randomized controlled trial of physiotherapy for postpartum stress incontinence: 7‐year follow‐up

To estimate the long‐term effect of intensive, 6‐week physiotherapy programs, with and without deep abdominal muscle (TrA) training, on persistent postpartum stress urinary incontinence (SUI).

Differences in pelvic floor morphology between continent, stress urinary incontinent, and mixed urinary incontinent elderly women: An MRI study

To compare magnetic resonance imaging (MRI) of the pelvic floor musculature (PFM), bladder neck and urethral sphincter morphology under three conditions (rest, PFM maximal voluntary contraction (MVC), and straining) in older women with symptoms of stress (SUI) or mixed urinary incontinence (MUI) or without incontinence.

P-Mate™, a new device allowing women to urinate in the standing position: urodynamic and satisfaction assessment

Urodynamic parameters and satisfaction were recorded after micturition in the seated position versus the standing position with a single-use device (P-Mate™) in healthy women. Healthy adult women were recruited. Eligibility criteria were: no past urological history and no urological symptoms. Volunteers were given four P-Mates™ to use during a week and a satisfaction questionnaire to fill. After this trial week, they were invited to perform four flowmetries, two in the seated position and two standing up, with the P-Mate™. Seated and standing flowmetry parameters were compared (by paired t-test). Twenty women completed the study. There was no difference in the maximum flow rate (Qmax), voided volume and post-void residual (PVR) in the standing versus the seated position. In terms of Qmax and PVR in healthy women, urinating standing up was as efficient as in the seated position. A majority of participants were satisfied with the device.

Pelvic floor muscles training to reduce symptoms and signs of vulvovaginal atrophy : a case study

Objective:Vulvovaginal atrophy (VVA), caused by decreased levels of estrogen, is a common problem in aging women. Main symptoms of VVA are vaginal dryness and dyspareunia. First-line treatment consists of the application of local estrogen therapy (ET) or vaginal moisturizer. In some cases however, symptoms and signs persist despite those interventions. This case study describes a 77-year-old woman with severe VVA symptoms despite use of local ET and the addition of pelvic floor muscle (PFM) training to her treatment. Methods:A patient with stress urinary incontinence and VVA was referred to a randomized clinical trial on PFM training. On pretreatment evaluation while on local ET, she showed VVA symptoms on the ICIQ Vaginal Symptoms questionnaire and the ICIQ-Female Sexual Matters associated with lower urinary tract Symptoms questionnaire, and also showed VVA signs during the physical and dynamometric evaluation of the PFM. She was treated with a 12-week PFM training program. Results:The patient reported a reduction in vaginal dryness and dyspareunia symptoms, as well as a better quality of sexual life after 12 weeks of PFM training. On posttreatment physical evaluation, the PFMs’ tone and elasticity were improved, although some other VVA signs remained unchanged. Conclusions:Pelvic floor muscle training may improve some VVA symptoms and signs in women taking local ET. Further study is needed to investigate and confirm the present case findings and to explore mechanisms of action of this intervention for VVA.

Test-retest reliability of clitoral blood flow measurements using color Doppler ultrasonography at rest and after a pelvic floor contraction task in healthy adult women

Test‐retest reliability assessment of the dorsal clitoral arterys blood flow at rest and after muscle activation has never been documented. If this outcome measure is to be used in conditions impeding vascularity, it requires a psychometric evaluation. The aim of this study was to assess the inter‐session test‐retest reliability of clitoral blood flow in healthy women using color Doppler ultrasonography at rest and after a pelvic floor muscle (PFM) contraction task.

Test–retest reliability of internal pudendal artery blood flow using color Doppler ultrasound in healthy women

Introduction and hypothesisThe internal pudendal artery (IPA) is one of the main arteries supplying the pelvic floor muscles (PFMs) and vulvo-vaginal tissues. Its assessment with color Doppler ultrasound has been documented previously, but the reliability of IPA measurements has never been assessed. This study evaluates the test–retest reliability of IPA blood flow parameters measured by color Doppler ultrasound under two conditions: at rest and after a PFM contraction task.MethodsTwenty healthy women participated in this study. One observer performed two measurement sessions using a clinical ultrasound system with a curved-array probe on the participant’s gluteal area. IPA measurements were repeated: at rest and after a PFM contraction task. Peak systolic velocity (PSV), time-averaged maximum velocity (TAMX), end-diastolic velocity (EDV), pulsatility index (PI), and resistance index (RI) were measured. Test–retest reliability was assessed using a paired t test, intraclass correlation coefficient (ICC), and Bland and Altman plots.ResultsThere was no significant difference for all IPA blood flow measurements between the two repeated sessions. At rest, reliability was excellent for PSV and TAMX and the variability between measurements, as per Bland and Altman plots, was small. After PFM contractions, reliability was excellent for PSV and TAMX and fair to good for PI. The variability between measurements was small for PSV and acceptable for TAMX and PI. EDV and RI parameters did not perform as well.ConclusionThe assessment of IPA blood flow with color Doppler ultrasound to evaluate vascular change in women is reliable.