User:Percentol/Urethral hypermobility/Bibliography

Urethral Hypermobility Sources
=== NEJM review from 2021 === Involuntary leakage of urine during coughing, sneezing, and physical exertion. Urethral hypermobility can reduce the amount of pressure that the urethra can exert against the pressure in the bladder. SUI is combination of Urethral hypermobility, and deficiency in intrinsic urethral sphincter.

Tx:

Midurethral sling (synthetic mesh), most successful. cure @ 1 year 62%-97%, Cure @ 5 years 43%-92%.

Also, birch colposuspension

Bulking. cystoscopic injection of bulking material. into urethral submucosa. Cure@ 1 year 26%.

Vaginal mesh for pelvic organ prolapse removed from market, equal efficacy and safety profile according to FDA but due to risk, requirement of superior safety and efficacy was added if any were to remain on market.

=== Quaghebeur 2021 Pelvic Floor Dysfunction === Theories of muscle physiology relating to proper function of pelvic floor, including contribution of pelvic floor function to "continence".

Integral theory is predominant one which can describe how hypermobility contributes to SUI.

Anatomy: suspensory ligaments (PUL, USL), form stable structure against which pelvic floor muscles contract to close off or open the urethra.

Laxity causes malfunction, and can contribute to chronic pain.

Complex reflex systems in place which cause muscle contractions to prevent leakage during increases in abdominal pressure.

Related conditions: CPPS, Pelvic girdle pain, sexual programs (dyspareunia), Lower Urinary Tract Symptoms (SUI, also urgency), Constipation, prolapse.

Conflict of theories muddies the water.

PFME cause 50% symptom improvement in 70%-80% of postmenopausal women with SUI.

=== Cho and Kim 2021 Pelvic floor muscle training to cope with urinary incontinence === parameters and anatomy of pelvic floor muscles, motivation for training approaches

=== Sheng et al 2022 Mechanisms of pelvic floor muscle training for managing urinary incontinence === Though PFME are effective (see Cho&Kim), physiological basis of pelvic floor strengthening is unclear. Direct evidence is lacking to explain how PFME improve SUI and address urethral hypermobility. Also non-repairable pelvic muscle floor tears from trauma during childbirth for example may respond differently to PFME than other causes of PFD, and this has not been covered in research.

=== Harland et al 2023, Stress Urinary Incontinence: An unsolved clinical challenge === Causes and treatments of urinary incontinence, open questions remain.

=== Veit-Rubin et al 2019 Burch Colposuspension === Open Burch colposuspension vs laparascopic vs. Mid Urethral Sling (MUS).

MUS has fewer complications than open, Objective cure rates higher in MUS than LapBurch. Cost higher in Lap Burch than Open Burch. New controversy over Mesh. Burch may be option after failed MUS.