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Impact of preoperative pelvic floor muscle training (pretraining) on urinary storage and emptying symptoms in women undergoing sling surgery

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Abstract

Introduction and hypothesis

Although pelvic floor muscle training (PFMT) is an option for female mixed incontinence (MUI), the role of PFMT prior to midurethral sling (MUS) surgery is not well defined. We hypothesize that preoperative PFMT (pretraining) positively impacts urinary storage and voiding symptoms prior to retropubic MUS.

Methods

We carried out an institutional review board-approved, retrospective chart review of women with stress-predominant MUI undergoing a retropubic MUS. Seventy-two women elected for initial PFMT before MUS (group 1). These were age-matched with 72 women who underwent MUS only (group 2). The primary outcome was the change in urinary voiding and storage symptoms (Emptying [E] and Inhibition [I; UUI] subsets of the SEAPI classification). Additional outcomes were stress urinary incontinence (SUI) resolution and change in quality of life (QoL) indices.

Results

Mean age and follow-up were 49 ± 12 years and 33 ± 12 months respectively. After MUS, SUI resolved in 79.2% and 69.4% in groups 1 and 2 respectively (p > 0.05). In group 1, 18% and 20.8% had improvement/resolution in the E and I subsets prior to MUS. Postoperatively, similar rates of improvement/resolution in the E (25% for both) and I (68% vs 63.9%) subsets were observed in groups 1 and 2 respectively. Postoperative QoL indices were statistically improved in both groups, with no significant difference between groups.

Conclusions

Pretraining with PFMT before MUS was associated with preoperative improvement in emptying symptoms and UUI. Although not statistically significant, pretraining was associated with a higher chance of SUI resolution in the long term. If pretraining is beneficial before MUS, the effect appears to be small.

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Authors and Affiliations

  1. LSU Health Shreveport School of Medicine, Shreveport, LA, USA

    Kathryn Nauman & Ann Stolzle

  2. Southern Surgical and Medical Specialists, Lafayette, LA, USA

    Laura Owens

  3. School of Allied Health Professions, LSU Health Shreveport, Shreveport, LA, USA

    Clifton F. Frilot II

  4. Department of Urology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71130, USA

    Alex Gomelsky

Authors
  1. Kathryn Nauman
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  2. Ann Stolzle
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  3. Laura Owens
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  4. Clifton F. Frilot II
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  5. Alex Gomelsky
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Contributions

K. Nauman: data collection, data analysis, manuscript writing; A. Stolzle: data collection, data analysis, manuscript writing; L. Owens: data collection, data analysis, manuscript writing; C. Frilot: data analysis; A. Gomelsky: project development, data collection, data analysis, manuscript writing/editing.

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Correspondence to Alex Gomelsky.

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Nauman, K., Stolzle, A., Owens, L. et al. Impact of preoperative pelvic floor muscle training (pretraining) on urinary storage and emptying symptoms in women undergoing sling surgery. Int Urogynecol J 33, 673–679 (2022). https://doi.org/10.1007/s00192-021-04870-3

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  • DOI: https://doi.org/10.1007/s00192-021-04870-3

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