Abstract
The aim of the study was the investigation of the biochemical condition of elements likely to directly participate in active closing of the urethral lumen. We estimated glycogenolysis in urinary bladder, perivesical connective tissue and levator ani muscle (LAM) samples obtained intraoperatively from 80 stress incontinent women. Glycogen content as well as activities of active and total glycogen phosphorylase and acid exo-1,4-alpha-glucosidase were measured. Material from the urinary bladder and perivesical connective tissue was insignificantly altered, and glycogen contents in the bladder (2.03±1.38 g/100 g wet tissue) were considered to be normal. In the LAM glycogenolysis was much more activated than in other tissues (p<0.001 by Fischer's exact test). Of LAM specimens 78% (22/28) revealed imbalanced biochemistry of glycogen with activation of hydrolytic decomposition. We conclude that stress urinary incontinence in women is frequently associated with metabolic alterations in the periurethral striated fibres. This study indirectly supports our recent hypothesis on the pathogenesis of the disease in terms of muscle fibre type transitions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Little, N. A., Juma, S., Raz, S.: Surgical treatment of stress urinary incontinence.Semin. Urol., 7, 86 (1989).
Klevmark, B., Kulseng-Hanssen, S.: Continence mechanism in the female.Scand. J. Urol. Nephrol. (Suppl.),138, 35 (1991).
Jóźwik, M.: Stress urinary incontinence in women—an overuse syndrome.Med. Hypotheses, 40, 381 (1993).
Stryer, L., Biochemistry, PWN, Warszawa 1986 (based on W. H. Freeman and Company edition, San Francisco and London 1981).
Awad, S. A., Gajewski, J. B., Katz, N. O., Acker-Roy, K.: Final diagnosis and therapeutic implications of mixed symptoms of urinary incontinence in women.Urology, 39, 352 (1992).
Ingelman-Sundberg, A.: Urinary incontinence in women, excluding fistulas.Acta Obstet. Gynecol. Scand., 31, 266 (1952).
Łotocki, W.: Diagnostic and therapeutic measures in women with urinary stress incontinence.Ginekol. Pol., 39, 897 (1968).
Tanagho, E. A., Smith, D. R.: The anatomy and function of the bladder neck.Br. J. Urol., 38, 54 (1966).
Öbrink, A., Bunne, G., Ingelman-Sundberg, A.: Pressure transmission to the preurethral space in stress incontinence.Urol. Res., 6, 135 (1978).
Koelbl, H., Strassegger, H., Riss, P. A., Gruber, H.: Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence.Obstet. Gynecol., 74, 789 (1989).
Hers, H. G., van Hoof, F.: Enzymes of glycogen degradation in biopsy material. In: Neufeld, E. F., Ginsburg, V. (eds) Methods in Enzymology. Volume VIII. Complex Carbohydrates. Academic Press, New York-London 1966.
Methfessel, H. D., Richter, H., Seliger, E., Retzke, U., Methfessel, G., Blau, U.: Estrogen- und Progesteronrezeptoren in mesenchymalen Strukturen des weiblichen Urogenitaltraktes.Zentralbl. Gynäkol., 111, 503 (1989).
Smith, P., Heimer, G., Norgren, A., Ulmsten, U.: Steroid hormone receptors in pelvic muscles and ligaments in women.Gynecol. Obstet. Invest., 30, 27 (1990).
Lo, S., Russell, J. C., Taylor, A. W.: Determination of glycogen in small tissue samples.J. Appl. Physiol., 28, 234 (1970).
Fiske, C. H., Subbarow, Y.: The colorimetric determination of phosphorus.J. Biol. Chem., 66, 375 (1925).
Meites, S.: Ultramicro glucose (enzymatic). In: Meites, S. (ed.): Standard Methods of Clinical Chemistry. Vol. V. Academic Press, New York-London 1965.
Lowry, O. H., Rosebrough, N. J., Farr, A. L., Randall, R. J.: Protein measurement with the Folin phenol reagent.J. Biol. Chem., 193, 265 (1951).
Ren, J. M., Broberg, S., Sahlin, K., Hultman, E.: Influence of reduced glycogen level on glycogenolysis during short-term stimulation in man.Acta Physiol. Scand., 139, 467 (1990).
Parks, A. G., Porter, N. H., Melzak, J.: Experimental study of the reflex mechanism controlling the muscles of the pelvic floor.Dis. Colon Rectum., 5, 407 (1962).
Porter, N. H.: A physiological study of the pelvic floor in rectal prolapse.Ann. R. Coll. Surg. Engl., 31, 379 (1962).
Gosling, J. A., Dixon, J. S., Critchley, H. O. D., Thomson, S.-A.: A comparative study of the human external sphincter and periurethral levator ani muscles.Br. J. Urol., 53, 35 (1981).
Polgar, J., Johnson, M. A., Weightman, D., Appleton, D.: Data on fibre size in thirty-six human muscles. An autopsy study.J. Neurol. Sci., 19, 307 (1973).
Gollnick, P. D., Armstrong, R. B., Saubert, IV, C. W., Piehl, K., Saltin, B.: Enzyme activity and fiber composition in skeletal muscle of untrained and trained men.J. Appl. Physiol., 33, 312 (1972).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jóźwik, M., Łotocki, W. & Jóźwik, M. Stress urinary incontinence in women. International Urology and Nephrology 28, 485–494 (1996). https://doi.org/10.1007/BF02550955
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02550955