Obstetrics & Gynecology Email Alerts
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Obstetrics & Gynecology 2007;110:354-362
© 2007 by The American College of Obstetricians and Gynecologists
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by DeLancey, J. O. L.
Right arrow Articles by Ashton-Miller, J. A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by DeLancey, J. O. L.
Right arrow Articles by Ashton-Miller, J. A.

ORIGINAL RESEARCH

Vaginal Birth and De Novo Stress Incontinence

Relative Contributions of Urethral Dysfunction and Mobility

John O. L. DeLancey, MD1,2, Janis M. Miller, RN, PhD2,3, Rohna Kearney, MD4, Denise Howard, MD, MPH5, Pranathi Reddy, MD6, Wolfgang Umek, MD7, Kenneth E. Guire, MS2,8 , Rebecca U. Margulies, MD1,2 and James A. Ashton-Miller, PhD2,9,10

From the1 Department of Obstetrics and Gynecology, 2Pelvic Floor Research Group, and 3School of Nursing, University of Michigan, Ann Arbor, Michigan; 4Cambridge University Hospitals, Cambridge, United Kingdom; 5Georgia Urogynecology, Fayetteville, Georgia; 6Division of Urogynecology, Rainbow Hospital for Women and Children, Hyderabad, India; 7Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria; and 8Department of Biostatistics, 9Department of Biomechanical Engineering, and 10Institute of Gerontology University of Michigan, Ann Arbor, Michigan.

OBJECTIVE: To evaluate the relative contributions of urethral mobility and urethral function to stress incontinence.

METHODS: This was a case-control study with group matching. Eighty primiparous women with self-reported new stress incontinence 9–12 months postpartum were compared with 80 primiparous continent controls to identify impairments specific to stress incontinence. Eighty nulliparous continent controls were evaluated as a comparison group to allow us to determine birth-related changes not associated with stress incontinence. Urethral function was measured with urethral profilometry, and vesical neck mobility was assessed with ultrasound and cotton swab test. Urethral sphincter anatomy and mobility were evaluated using magnetic resonance imaging. The associations among urethral closure pressure, vesical neck movement, and incontinence were explored using logistic regression.

RESULTS: Urethral closure pressure (±standard deviation) in primiparous incontinent women (62.9±25.2 cm H20) was lower than in primiparous continent women (83.9±21.0, P<.001; effect size d=0.91) who were similar to nulliparous women (90.3±25.0, P=.091). Vesical neck movement measured during cough with ultrasonography was the mobility measure most associated with stress incontinence; 15.6±6.2 mm in incontinent women compared with 10.9±6.2 in primiparous continent women (P<.001, d=0.76) or nulliparas (9.9±5.0, P=.322). Logistic regression disclosed the two-variable model (max-rescaled R2=0.37, P<.001) was more strongly associated with stress incontinence than either single-variable model, urethral closure pressure (R2=0.25, P<.001) or vesical neck movement (R2=0.16 P<.001).

CONCLUSION: Lower maximal urethral closure pressure is the measure most associated with de novo stress incontinence after first vaginal birth followed by vesical neck mobility.

LEVEL OF EVIDENCE: II






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the American College of Obstetricians and Gynecologists.