Étude comparative de la morphologie du plancher pelvien des femmes âgées continentes et avec incontinence urinaire

But: Cette étude a pour but de comparer : a)la morphologie du plancher pelvien (PP), du col vésical et du sphincter urogénital strié (SUS) par IRM et b) la fonction du PP par palpation digitale (PERFECT scheme) chez les femmes âgées continentes ou avec incontinence urinaire à l’effort (IUE) et mixte (IUM). Méthode: Les femmes ont appris à contracter correctement leur PP et la fonction de leur PP a été évaluée. Une séance d’IRM dynamique 3T a suivi. Résultats: 66 femmes ont participé à l’étude. Les groupes étaient similaires en âge, IMC, nombre d’accouchements vaginaux et d’hystérectomie. La validité et la fidélité des différentes mesures anatomiques utilisées ont été confirmées au début de cette étude. Afin de contrôler l’effet potentiel de la taille du bassin sur les autres paramètres, les femmes ont été appariées par la longueur de leur inlet pelvien. Les femmes avec IUM ont un PP plus bas et un support des organes pelviens plus faible, selon leurs ligne M, angle LPC/Ligne H et hauteur de la jonction urétro-vésicale (UV). Les femmes avec IUE ont un PP similaire à celui des continentes, mais présentent plus d’ouverture du col vésical et un angle UV postérieur plus large au repos que les autres groupes. Il n’y a aucune différence de morphologie du SUS entre les groupes. De plus, selon les résultats du PERFECT scheme, les femmes avec IU ont une force du PP plus faible que les continentes. Les femmes avec IUM montrent aussi une faible élévation des muscles du PP à la contraction. Les femmes avec IUE ont, quant à elle, un problème de coordination à la toux. Conclusion: Les déficits causant l’IUE et l’IUM sont différents, mais supportent tous le rationnel des exercices du PP pour le traitement de l’IUE et l’IUM. Ces résultats supportent le besoin de traitements de rééducation spécifiques aux déficits de chacun des types d’IU.Aims: The study’s aim was to compare: a) pelvic floor muscle (PFM), bladder neck and urethral sphincter morphologies using MRI and b) PFM function using digital palpation (PERFECT scheme) in continent women, women with stress (SUI) and mixed (MUI) urinary incontinence. Method: Women were taught how to perform PFM contractions correctly and their PFM function was assessed, then each woman completed a dynamic 3T MRI session. Results: 66 women participated in the study. Groups were similar for age, BMI, vaginal deliveries and hysterectomies. Validity and reliability of the different anatomical measures used has been confirmed at the beginning of the study. To control for the potential effect of pelvic size on study parameters, women were matched based on pelvic inlet length. MUI women seemed to have lower PFM resting position and pelvic organ support at rest, based on their M-Line, PCL/H-Line angle and urethrovesical (UV) junction height. However, SUI women seemed to have a PFM morphology similar to that of continent women, but presented a greater occurrence of bladder neck funnelling and a larger posterior UV angle. There were no differences in urethral sphincter morphology between the 3 groups. Functionally, as shown by the PERFECT scheme results, both UI groups had poorer PFM strength on MVC then continent women. The MUI group also showed poor PFM elevation on contraction. Conversely, women with SUI had a timing problem on cough. Conclusion: The deficits in women with SUI and MUI appear to be very different. Notwithstanding, they all support the rationale for PFM exercise treatment in older women with SUI and MUI. However, the findings suggest the need for rehabilitation treatments specificity for each UI type

Comparison of two methods for measuring the pubococcygeal line from sagittal-plane magnetic resonance imaging

Aims The pubococcygeal line (PCL) is an important reference line for determining measures of pelvic organ support on sagittal-plane magnetic resonance imaging (MRI); however, there is no consensus on where to place the posterior point of the PCL. As coccyx movement produced during pelvic floor muscle (PFM) contractions may affect other measures, optimal placement of the posterior point is important. This study compared two methods for measuring the PCL, with different posterior points, on T2-weighted sagittal MRI to determine the effect of coccygeal movement on measures of pelvic organ support in older women. Methods MRI of the pelvis was performed in the midsagittal plane, at rest and during PFM contractions, on 47 community-dwelling women 60 and over. The first PCL was measured to the tip of the coccyx (PCLtip) and the second to the sacrococcygeal joint (PCLjnt). Four measures of pelvic organ support were made using each PCL as the reference line: urethrovesical junction height, uterovaginal junction height, M-line and levator plate angle. Results During the PFM contraction the PCLtip shortened and lifted (P  0.05). The changes in the four measures of pelvic organ support were smaller when measured relative to the PCLtip as compared to those to the PCLjnt (P < 0.001). Conclusions Coccyx movement affected the length and position of the PCLtip, which resulted in underestimates of the pelvic-organ lift produced by the PFM contraction. Therefore, we recommend that the PCL be measured to the sacrococcygeal joint and not to the tip of the coccy

Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence

Introduction and hypothesis The purpose of this study was to evaluate the effects of a pelvic floor muscle (PFM) rehabilitation program on the striated urethral sphincter in women over 60 years with stress urinary incontinence (SUI). We hypothesized that the PFM rehabilitation program would also exercise the striated urethral sphincter and that this would be demonstrated by hypertrophy of the sphincter on magnetic resonance imaging (MRI). Methods Women with at least weekly episodes of SUI were recruited. Participants were evaluated before and after a 12-week group PFM rehabilitation intervention with T2-weighted fast-spin-echo MRI sequences recorded in the axial plane at rest to assess urethral sphincter size. Data on SUI symptoms and their bother were also collected. No control group was included. Results Seventeen women participated in the study. The striated urethral sphincter increased significantly in thickness (21 %, p < 0.001), cross-sectional area (20 %, p = 0.003), and volume (12 %, p = 0.003) following the intervention. The reported number of incontinence episodes and their bother also decreased significantly. Conclusions This study appears to demonstrate that PFM training for SUI also trains the striated urethral sphincter and that improvement in incontinence signs and symptoms is associated with sphincter hypertrophy in older women with SUI. These findings support previous ultrasound (US) data showing an increase in urethral cross-sectional area following PFM training and extend the previous findings by more specifically assessing the area of hypertrophy and by demonstrating that older women present the same changes as younger women when assessed using MRI data

Pelvic floor morphometry : a predictor of success of pelvic floor muscle training for women with stress and mixed urinary incontinence

Introduction and hypothesis: The aim of this study was to determine if pelvic floor muscle (PFM) morphometry at baseline, as measured by MRI, can predict response to PFM training in women with stress or mixed urinary incontinence (UI). Methods: This study was a prospective quasi-experimental pre-test, post-test cohort study of women with UI, aged 60 years and older. All participants completed a baseline assessment of UI severity and impact, using the 72-h bladder diary and the Incontinence Impact Questionnaire. They underwent a pelvic MRI examination to assess the PFM anatomy. Women then participated in a 12-week PFM training program. Finally, they attended a post intervention assessment of UI severity and impact. The association between morphometry and PFM training response was assessed by univariate analysis, multivariate analysis, and receiver operating characteristic (ROC) curve analysis. Results: The urethro-vesical junction height at rest, as measured by MRI before treatment, was associated with response to PFM training both on univariate (p ≤ 0.005) and multivariate analyses (p = 0.007). The area under the ROC curve was 0.82 (95% confidence interval [CI]: 0.67-0.96). Using a cut-off point of 11.4 mm, participants' response to PFM training was predicted with a sensitivity of 77% and a specificity of 83%. Incontinent women with a urethro-vesical junction height above this threshold were 35% more likely to respond to PFM training (OR 1.35; 95% CI: 1.08-1.67). Conclusion: In older women with UI, a urethro-vesical junction height at rest of at least 11.4 mm appears to be predictive of PFM training response

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

Aims 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. Methods This 2008–2012 exploratory observational cohort study was conducted with community-dwelling women aged 60 and over. Sixty six women (22 per group), mean age of 67.7 ± 5.2 years, participated in the study. A 3 T MRI examination was conducted under three conditions: rest, PFM MVC, and straining. ANOVA or Kruskal–Wallis tests (data not normally distributed) were conducted, with Bonferroni correction, to compare anatomical measurements between groups. Results Women with MUI symptoms had a lower PFM resting position (M-Line P = 0.010 and PC/H-line angle P = 0.026) and lower pelvic organ support (urethrovesical junction height P = 0.013) than both continent and SUI women. Women with SUI symptoms were more likely to exhibit bladder neck funneling and a larger posterior urethrovesical angle at rest than both continent and MUI women (P = 0.026 and P = 0.008, respectively). There were no significant differences between groups on PFM MVC or straining. Conclusions Women with SUI and MUI symptoms present different morphological defects at rest. These observations emphasize the need to tailor UI interventions to specific pelvic floor defects and UI type in older women

Narrative discourse in young and older adults: behavioral and NIRS analyses

Discourse comprehension is at the core of communication capabilities, making it an important component of elderly populations' quality of life. The aim of this study is to evaluate changes in discourse comprehension and the underlying brain activity. Thirty-six participants read short stories and answered related probes in three conditions: micropropositions, macropropositions and situation models. Using near-infrared spectroscopy (NIRS), the variation in oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations was assessed throughout the task. The results revealed that the older adults performed with equivalent accuracy to the young ones at the macroproposition level of discourse comprehension, but were less accurate at the microproposition and situation model levels. Similar to what is described in the compensation-related utilization of neural circuits hypothesis (CRUNCH) model, older participants tended to have greater activation in the left dorsolateral prefrontal cortex while reading in all conditions. Although it did not enable them to perform similarly to younger participants in all conditions, this over-activation could be interpreted as a compensation mechanism

Narrative Discourse in Young and Older Adults: Behavioral and NIRS Analyses

Discourse comprehension is at the core of communication capabilities, making it an important component of elderly populations’ quality of life. The aim of this study is to evaluate changes in discourse comprehension and the underlying brain activity. Thirty-six participants read short stories and answered related probes in three conditions: micropropositions, macropropositions and situation models. Using near-infrared spectroscopy (NIRS), the variation in oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations was assessed throughout the task. The results revealed that the older adults performed with equivalent accuracy to the young ones at the macroproposition level of discourse comprehension, but were less accurate at the microproposition and situation model levels. Similar to what is described in the compensation-related utilization of neural circuits hypothesis (CRUNCH) model, older participants tended to have greater activation in the left dorsolateral prefrontal cortex while reading in all conditions. Although it did not enable them to perform similarly to younger participants in all conditions, this over-activation could be interpreted as a compensation mechanism

Narrative Discourse in Young and Older Adults: Behavioral and NIRS Analyses

ABSTRACT: Discourse comprehension is at the core of communication capabilities, making it an important component of elderly populations' quality of life. The aim of this study is to evaluate changes in discourse comprehension and the underlying brain activity. Thirty-six participants read short stories and answered related probes in three conditions: micropropositions, macropropositions and situation models. Using near-infrared spectroscopy (NIRS), the variation in oxyhemoglobin (HbO2) and deoxyhemoglobin (HbR) concentrations was assessed throughout the task. The results revealed that the older adults performed with equivalent accuracy to the young ones at the macroproposition level of discourse comprehension, but were less accurate at the microproposition and situation model levels. Similar to what is described in the compensation-related utilization of neural circuits hypothesis (CRUNCH) model, older participants tended to have greater activation in the left dorsolateral prefrontal cortex while reading in all conditions. Although it did not enable them to perform similarly to younger participants in all conditions, this over-activation could be interpreted as a compensation mechanism