University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Nagyerdei krt. 98, 4032 Debrecen, Hungary.
University of Debrecen, Faculty of Medicine, Department of Obstetrics and Gynecology, Nagyerdei krt. 98, 4032 Debrecen, Hungary; Eastern Virginia Medical School Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, 825 Fairfax Avenue, Suite 526, Norfolk, VA 23507-2007, USA.
Eur J Obstet Gynecol Reprod Biol. 2024 Nov;302:283-287. doi: 10.1016/j.ejogrb.2024.09.037. Epub 2024 Sep 25.
Our study aimed to improve the understanding of the biomechanical changes occurring in the pelvic floor due to pelvic floor muscle training (PFMT), which is responsible for improving stress urinary incontinence (SUI) symptoms.
In this prospective cohort study, we examined the impact of a six-week PFMT program in women with stress or stress-predominant urinary incontinence on the biomechanical parameters of the pelvic floor. Fifty-two biomechanical parameters were measured by Vaginal Tactile Imager (VTI) at baseline and at a six-week follow-up. In addition, we have assessed the Urinary Distress Inventory (UDI-6), Incontinence Impact Questionnaire (IIQ-7), and Patient's Global Impression of Severity (PGI-S) scores at enrolment and at six-week follow-up. We have divided our cohort into two groups, Improved Group (IG) and Not-improved Group (NIG), based on the change in UDI-6 score after six weeks and compared the biomechanical changes within and between the two groups.
The overall cohort included twenty women with stress or stress-predominant SUI based on MESA questionnaire [MESA SUI index (mean ± SD) 63.3 % ± 24.0 %, MESA UUI index (mean ± SD) 13.3 % ± 15.3 %, p < 0.01]. Nine of the 52 VTI parameters have changed significantly after six weeks of PFMT in the entire cohort. Eleven women (IG) achieved the minimum 11-point change in the UDI-6 scaled score. In IG, we found that three VTI parameters differed significantly: Parameter 1: the maximum value of force measured during the VTI probe insertion [(N, mean ± SD) 0.55 ± 0.18 vs. 0.78 ± 0.31, p < 0.049], parameter 18: the maximum gradient at the upper third of the vagina (posterior) [(kPa/mm, mean ± SD) 0.16 ± 0.05 vs. 0.36 ± 0.28, p < 0.048], and parameter 47: integral force change in the anterior compartment at reflex pelvic muscle contraction (cough) [(N, mean ± SD) 1.61 ± 0.85 vs. 1.97 ± 0.71, p < 0.045].
Our study revealed a significant association between the improvement of strength in targeted muscle groups and a reduction in urinary incontinence symptoms. Identifying specific muscles changing PFMT provides valuable insights for specific interventions. Our findings may help to create personalized and targeted interventions to improve the quality of life of women affected by SUI.
本研究旨在提高对盆底肌训练（PFMT）引起的盆底生物力学变化的理解，PFMT 可改善压力性尿失禁（SUI）症状。
在这项前瞻性队列研究中，我们检查了为期六周的 PFMT 方案对患有压力性或压力主导性尿失禁的女性盆底生物力学参数的影响。基线和六周随访时使用阴道触觉成像仪（VTI）测量了 52 个生物力学参数。此外，我们在入组时和六周随访时评估了尿失禁困扰量表（UDI-6）、尿失禁影响问卷（IIQ-7）和患者总体严重程度印象评分（PGI-S）。我们根据六周后 UDI-6 评分的变化将队列分为改善组（IG）和未改善组（NIG），并比较了两组内和两组间的生物力学变化。
整个队列包括 20 名基于 MESA 问卷有压力性或压力主导性 SUI 的女性[MESA SUI 指数（均值±标准差）63.3%±24.0%，MESA UUI 指数（均值±标准差）13.3%±15.3%，p<0.01]。整个队列中，有 9 个 VTI 参数在六周的 PFMT 后发生了显著变化。11 名女性（IG）在 UDI-6 评分上达到了最小的 11 分变化。在 IG 中，我们发现有三个 VTI 参数有显著差异：参数 1：VTI 探头插入过程中测量的最大力值[（N，均值±标准差）0.55±0.18 与 0.78±0.31，p<0.049]；参数 18：阴道上三分之一（后）的最大梯度（kPa/mm，均值±标准差）0.16±0.05 与 0.36±0.28，p<0.048]；参数 47：反射性盆底肌肉收缩（咳嗽）时前隔室积分力变化[（N，均值±标准差）1.61±0.85 与 1.97±0.71，p<0.045]。
我们的研究表明，在目标肌肉群力量的改善与尿失禁症状的减轻之间存在显著关联。确定发生变化的特定肌肉可为特定干预措施提供有价值的见解。我们的发现可能有助于制定个性化和针对性的干预措施，以提高受 SUI 影响的女性的生活质量。
