UROKIN: A Software to Enhance Our Understanding of Urogenital Motion
- 68 Downloads
Transperineal ultrasound (TPUS) allows for objective quantification of mid-sagittal urogenital mechanics, yet current practice omits dynamic motion information in favor of analyzing only a rest and a peak motion frame. This work details the development of UROKIN, a semi-automated software which calculates kinematic curves of urogenital landmark motion. A proof of concept analysis, performed using UROKIN on TPUS video recorded from 20 women with and 10 women without stress urinary incontinence (SUI) performing maximum voluntary contraction of the pelvic floor muscles. The anorectal angle and bladder neck were tracked while the motion of the pubic symphysis was used to compensate for the error incurred by TPUS probe motion during imaging. Kinematic curves of landmark motion were generated for each video and curves were smoothed, time normalized, and averaged within groups. Kinematic data yielded by the UROKIN software showed statistically significant differences between women with and without SUI in terms of magnitude and timing characteristics of the kinematic curves depicting landmark motion. Results provide insight into the ways in which UROKIN may be useful to study differences in pelvic floor muscle contraction mechanics between women with and without SUI and other pelvic floor disorders. The UROKIN software improves on methods described in the literature and provides unique capacity to further our understanding of urogenital biomechanics.
KeywordsStress urinary incontinence Pelvic floor muscles Maximum voluntary contraction Urogenital kinematics
The authors would like to acknowledge Kevin Varette, P.T. for his contributions to the data acquisition. This work was supported by the Canadian Institutes of Health Research (CIHR-IRSC 0076433) and the Natural Sciences and Engineering Research Council of Canada (NSERC 05256).
- 5.DeLancey, J. O. L., J. M. Miller, R. Kearney, et al. Vaginal birth and de novo stress incontinence. Obstet. Gynecol. 110(2, Part 1):354–362, 2007. https://doi.org/10.1097/01.aog.0000270120.60522.55.CrossRefPubMedPubMedCentralGoogle Scholar
- 13.Dumoulin, C., D. Bourbonnais, M. Morin, D. Gravel, and M. C. Lemieux. Predictors of success for physiotherapy treatment in women with persistent postpartum stress urinary incontinence. Arch. Phys. Med. Rehabil. 91(7):1059–1063, 2010. https://doi.org/10.1016/j.apmr.2010.03.006.CrossRefPubMedGoogle Scholar
- 14.Hoyte, L., L. Schierlitz, K. Zou, G. Flesh, and J. R. Fielding. Two- and 3-dimensional MRI comparison of levator ani structure, volume, and integrity in women with stress incontinence and prolapse. Am. J. Obstet. Gynecol. 185(1):11–19, 2001. https://doi.org/10.1067/mob.2001.116365.CrossRefPubMedGoogle Scholar
- 21.McLean, L., K. Varette, E. Gentilcore-Saulnier, M.-A. Harvey, K. Baker, and E. Sauerbrei. Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing. Neurourol. Urodyn. 32(8):1096–1102, 2013. https://doi.org/10.1002/nau.22343.CrossRefPubMedPubMedCentralGoogle Scholar
- 24.Peng, Q., R. C. Jones, K. Shishido, and C. E. Constantinou. Ultrasound evaluation of dynamic responses of female pelvic floor muscles. Ultrasound Med. Biol. 33(3):342–352, 2007. https://doi.org/10.1016/j.ultrasmedbio.2006.08.020.CrossRefPubMedPubMedCentralGoogle Scholar
- 28.Pregazzi, R., A. Sartore, P. Bortoli, E. Grimaldi, L. Troiano, and S. Guaschino. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence. BJOG An. Int. J. Obstet. Gynaecol. 109(7):821–827, 2002. https://doi.org/10.1111/j.1471-0528.2002.01163.x.CrossRefGoogle Scholar
- 32.Thibault-Gagnon, S., C. Auchincloss, R. Graham, and L. McLean. The temporal relationship between activity of the pelvic floor muscles and motion of selected urogenital landmarks in healthy nulliparous women. J. Electromyogr. Kinesiol. 2017(38):126–135, 2017. https://doi.org/10.1016/j.jelekin.2017.11.012.Google Scholar
- 34.Winter, D. A. Biomechanics and Motor Control of Human Movement (3rd ed.). Hoboken: Wiley, 2005.Google Scholar