Okui Nobuo, Ikegami Tadashi, Mikic Aleksandra Novakov, Okui Machiko, Gaspar Adrian
Dentistry, Kanagawa Dental University, Kanagawa, JPN.
Diagnostic Imaging, Kanagawa Dental University, Kanagawa, JPN.
Cureus. 2023 Mar 27;15(3):e36730. doi: 10.7759/cureus.36730. eCollection 2023 Mar.
Stress urinary incontinence (SUI) is increasing in elite female athletes (EFAs), affecting competition results and quality of life. Pelvic floor muscle training (PFMT) is the first-line treatment for SUI, and surgery is generally performed when PFMT is insufficient. However, in EFA, there are few cases in which surgery is performed and fewer reports. Therefore, there is no known general treatment strategy for EFA with SUI. In our study, a 23-year-old track-and-field medalist with severe SUI was successfully treated with a vaginal and urethral erbium-doped yttrium aluminum garnet laser (VEL + UEL). After 12 treatments over one year, urinary incontinence decreased from 300 mL or more in the 400 m track run before treatment to 0 mL. She did not experience any more problems during running or competition. There was no recurrence of SUI for three years, and the urethral pressure profile examination confirmed improvement. MRIs showed that the left puborectalis muscle was absent from the first visit. The urethra was oval with an anteroposterior outer diameter of 10 mm and a transverse outer diameter of 13 mm before treatment. However, after three years of treatment, both anteroposterior and transverse diameters became circular, measuring 11 mm. Vaginal wall thickness increased from 8 to 12 mm at the center of the height of the urethra, making it possible to support the urethra, and pretreated adipose tissue space between the urethra and vagina disappeared. It was noted that the uneven and fragile urethra/vagina, the presence of adipose tissue space, and the absence of the left puborectalis muscle may have been the cause of the SUI. One year of VEL + UEL treatment resulted in long-term improvement of SUI; MRI showed changes in the urethra and vagina.
压力性尿失禁（SUI）在精英女性运动员（EFA）中的发病率呈上升趋势，这会影响比赛成绩和生活质量。盆底肌训练（PFMT）是SUI的一线治疗方法，当PFMT效果不佳时通常会进行手术。然而，在EFA中，接受手术的病例很少，相关报道也较少。因此，目前尚无针对患有SUI的EFA的通用治疗策略。在我们的研究中，一名患有严重SUI的23岁田径奖牌获得者通过阴道和尿道掺铒钇铝石榴石激光（VEL + UEL）成功治愈。经过一年的12次治疗后，尿失禁量从治疗前400米跑道跑时的300毫升或更多降至0毫升。她在跑步或比赛中不再出现任何问题。SUI三年未复发，尿道压力分布检查证实有所改善。MRI显示初次就诊时左侧耻骨直肠肌缺失。治疗前尿道呈椭圆形，前后外径为10毫米，横向外径为13毫米。然而，经过三年治疗后，前后径和横向径均变为圆形，测量值为11毫米。尿道高度中心处的阴道壁厚度从8毫米增加到12毫米，从而能够支撑尿道，并且治疗前尿道与阴道之间的脂肪组织间隙消失。值得注意的是，尿道/阴道不均匀且脆弱、存在脂肪组织间隙以及左侧耻骨直肠肌缺失可能是导致SUI的原因。VEL + UEL治疗一年导致SUI长期改善；MRI显示尿道和阴道发生了变化。
