Structural aspects of urethrovesical function in the female

Urodynamic investigations have provided detailed physiologic information which raises morphologic questions not easily answered by older descriptions of urethral anatomy. This article describes urethrovesical structure specifically as it has to do with urodynamic evaluation of the lower urinary tract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38467/1/1930070602_ftp.pd

Pubovesical ligament: A separate structure from the urethral supports (“pubo-urethral ligaments”)

The position and mobility of the vesical neck influences not only continence but also the initiation of micturition. During an examination of urethral topography, there appeared to be two structures running from the region around the vesical neck to the pelvic walls which might influence vesical neck function. These structures, the urethral supports (“pubo-urethral ligaments”) and pubovesical ligaments, have previously been considered to be synonymous terms for a single structure. To investigate this disparity, 1,500 serial histologic sections from eight normal cadavers were examined, 28 cadavers were dissected, and whole pelvis cross sections from an embalmed cadaver were studied. Our observations indicate that there are two structures which run from the region around the proximal urethra and vesical neck to attach to the pelvic walls. The pubovesical ligaments are an extension of the detrusor muscle and its adventitia. They attach to the pubic bone and arcus tendineus fasciae pelvis. Their structure suggests that they contract to assist in vesical neck opening but would be poorly suited to provide support for the proximal urethra. The other structures represent the urethral supports (“pubo-urethral ligaments”) which connect the vagina and periurethral tissues to the muscles of the pelvic diaphragm and to the pelvic fasciae. Their structure appears to be adequate to explain urethral support. There are, therefore, two structures running from the tissues around the vesical neck to the pelvic walls. The structure of the pubovesical ligament suggests that it could assist in vesical neck opening, and the urethral supports could determine urethral position.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/38469/1/1930080106_ftp.pd

Regarding “Letter to the Editor: Misconceptions derived from the use of microtip catheters in tissue,” Fred Miyazaki (1996): Neurourol. Urodynam. 15:672 and “Author's Reply: Misconceptions derived from the use of microtip catheters in tissue,” P.E. Papa Petros (1996): Neurourol. Urodynam. 15:673

No abstract.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34910/1/7_ftp.pd

The pathophysiology of stress urinary incontinence in women and its implications for surgical treatment

Stress urinary incontinence is a symptom that arises from damage to the muscles, nerves, and connective tissue of the pelvic floor. Urethral support, vesical neck function, and function of the urethral muscles are important determinants of continence. The urethra is supported by the action of the levator ani muscles through their connection to the endopelvic fascia of the anterior vaginal wall. Damage to the connection between this fascia and muscle, loss of nerve supply to the muscle, or direct muscle damage can influence continence. In addition, loss of normal vesical neck closure can result in incontinence despite normal urethral support. Although the traditional attitude has been to ignore the urethra as a factor contributing to continence, it does play a role in determining stress continence since in 50% of continent women, urine enters the urethra during increases in abdominal pressure, where it is stopped before it can escape from the external meatus. Perhaps one of the most interesting yet least acknowledged aspects of continence control concerns the coordination of this system. The muscles of the urethra and levator ani contract during a cough to assist continence, and little is known about the control of this phenomenon. That operations cure stress incontinence without altering nerve or muscle function should not be misinterpreted as indicating that these factors are unimportant.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/47055/1/345_2005_Article_BF02202011.pd

Convolutional neural network- based pelvic floor structure segmentation using magnetic resonance imaging in pelvic organ prolapse

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/162690/2/mp14377.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/162690/1/mp14377_am.pd

Self-report of difficult defecation is associated with overactive bladder symptoms

Aims The association of dysfunctional bowel elimination with lower urinary tract symptoms is well known in children, but not in adults. It was our objective to assess lower urinary tract symptoms (LUTS) in women who report difficult defecation (DD). Methods This is a secondary analysis of 2,812 women, aged 35–64, who participated in a telephone interview. All subjects were asked “When you move your bowels, does the stool come out easily?” DD was considered present in those answering “no.” All subjects were queried regarding LUTS, urinary infections in the past year, self-perceived health status, medical history, and demographics. Symptoms of stress incontinence (five items), urge incontinence (five items), and the impact of these symptoms on their quality of life were solicited from subjects reporting more than 12 episodes of incontinence in 1 year. Results DD was reported by 10.4% (290/2,790) of women. Women with DD had higher LUTS than those who did not: nocturia (mean 1.8 ± 0.1 vs. 1.3 ± 0.0), urgency (47.6% vs. 29.2%), increased daytime frequency (mean 8.2 ± 0.3 vs. 7.2 ± 0.1), dysuria (22.9% vs. 13.7%), and a sensation of incomplete bladder emptying (55.6% vs. 28.2%). DD women were more often menopausal, reported a fair or poor self-reported health status, and had a higher number of comorbidities, less formal education, and lower annual household income. Conclusions Women with symptoms of DD have an increased rate of LUTS, consistent with the diagnosis of overactive bladder without incontinence. The pathophysiology underlying this association is worthy of future research. Neurourol. Urodynam. 29:1290–1294, 2010. © 2009 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/78056/1/20839_ftp.pd

A screening tool for clinically relevant urinary incontinence

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/111206/1/nau22564.pd

Pelvic floor MRI segmentation based on semi-supervised deep learning

The semantic segmentation of pelvic organs via MRI has important clinical significance. Recently, deep learning-enabled semantic segmentation has facilitated the three-dimensional geometric reconstruction of pelvic floor organs, providing clinicians with accurate and intuitive diagnostic results. However, the task of labeling pelvic floor MRI segmentation, typically performed by clinicians, is labor-intensive and costly, leading to a scarcity of labels. Insufficient segmentation labels limit the precise segmentation and reconstruction of pelvic floor organs. To address these issues, we propose a semi-supervised framework for pelvic organ segmentation. The implementation of this framework comprises two stages. In the first stage, it performs self-supervised pre-training using image restoration tasks. Subsequently, fine-tuning of the self-supervised model is performed, using labeled data to train the segmentation model. In the second stage, the self-supervised segmentation model is used to generate pseudo labels for unlabeled data. Ultimately, both labeled and unlabeled data are utilized in semi-supervised training. Upon evaluation, our method significantly enhances the performance in the semantic segmentation and geometric reconstruction of pelvic organs, Dice coefficient can increase by 2.65% averagely. Especially for organs that are difficult to segment, such as the uterus, the accuracy of semantic segmentation can be improved by up to 3.70%

Urinary incontinence symptoms during and after pregnancy in continent and incontinent primiparas

Examine patterns of urinary incontinence during and after pregnancy, as recalled by incontinent and continent primiparas.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/45852/1/192_2006_Article_124.pd

Racial differences in self‐reported healthcare seeking and treatment for urinary incontinence in community‐dwelling women from the EPI study

Aims Objectives of this study are: (1) to examine the prevalence of healthcare seeking among black and white women with self‐reported urinary incontinence (UI), (2) to investigate barriers to treatment for incontinence, and (3) To investigate commonly used therapeutic modalities for UI. Methods This is a planned secondary analysis of responses from 2,812 black and white community‐dwelling women living in southeastern Michigan, aged 35–64 years, who completed a telephone interview concerning UI, healthcare‐seeking behaviors and management strategies. The study population was 571 subjects (278 black, 293 white) who self‐identified as having urinary incontinence. Results Of these women with UI, 51% sought healthcare with no statistically significant difference between the two races (53% black, 50.6% white, P  = 0.64). In multivariate logistic regression analysis, a higher likelihood of seeking healthcare was associated with increased age, body mass index lower than 30 kg/m 2 , prior surgery for UI, having regular pelvic exams, having a doctor, and worsening severity of UI. There was no significant association between hypothesized barriers to care seeking and race. Almost 95% of the subjects identified lack of knowledge of available treatments as one barrier. Black and white women were similar in percentage use of medications and some self‐care strategies, for example, pad wearing and bathroom mapping, but black women were significantly more likely to restrict fluid intake than white women and marginally less likely to perform Kegels. Conclusions Black and white women seek healthcare for UI at similar, low rates. Improved patient‐doctor relationships and public education may foster healthcare seeking behavior. Neurourol. Urodynam. Neurourol. Urodynam. 30: 1442–1447, 2011. © 2011 Wiley Periodicals, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/87061/1/21145_ftp.pd