Quin és el paper del múscul transvers abdominal en el manteniment de la continència urinària?

Abstract

The most common urogynecological dysfunction in women is urinary incontinence. Its prevalence is highly variable and it is becoming a growing problem that affects the quality of life of our patients. In recent decades, ultrasound has acquired a significant role in the study of urinary incontinence due to its cost, safety, portability and accessibility. Thanks to its use, the anatomical-morpho-functional knowledge of the pelvic floor has been improved, changing the diagnostic paradigm and the therapeutic approach of our patients. Pelvic floor muscle strengthening exercises with high evidence are the gold standard treatment for stress urinary incontinence (SUI). However, not all patients with urinary incontinence (UI) improve their clinical condition despite improving their Oxford. The etiological mechanism of UI is multifactorial and the specific role of the transversus abdominis muscle in this dysfunction is still poorly understood. This is a clinical study that aims to improve the diagnosis of our patients, with epidemiological and ultrasound data. Also clarifying the role that the transversus abdominis muscle (TA) can play in maintaining urinary continence. The main objective is to measure the thickness of the transversus abdominis at rest (TTR) and in maximum contraction of the pelvic floor muscles (TTC) in continent and incontinent patients. Analyze the differences in these measures and study whether they can be an independent predictor factor of continence in premenopausal women. Secondary objectives: Observe if abdominoperineal synergism exists in incontinent patients. Assess whether it is a reproducible technique for its clinical applicability. Assess whether there are differences regarding the type and severity of incontinence. A prospective, observational, single-blind study was proposed in women over 18 years of childbearing age, after signing the informed consent. Exclusion criteria: being pregnant, delivery during the previous twelve months, suffering low back pain, neurological or psychiatric condition that interferes with the understanding and correct performance of the exercises. Epidemiological and ultrasound variables were collected. The ultrasound variables were measured with two-dimensional ultrasound in the supine position and semi-flexed knees. The thickness of the TA at rest (TTR) and after 3-4 seconds of maximum pelvic floor contraction (TTC) was measured in the total sample. A new variable was defined: Transversus Ratio=((TTC-TTR))/(TTR ) x 100 to avoid inter-individual bias. The statistical package SPSS version 21.0 was used for data analysis. The reproducibility of the TA measurement using intraclass correlation coefficients was analysed. A bivariate analysis of the variables under study was carried out and a multivariate analysis was carried out to see their influence on continence or its severity (ICIQ-SF). A total of 515 women were evaluated: 48.5% incontinent, 51.5% continent. A synergistic abdomino perineal contraction was observed in all participants (except one with Oxford=0). The intraclass correlation coefficient was 0,94 for TTR, and 0.93 for TTC (p = 0.00). The ultrasonographic variables of the transverse thicknesses were not shown as an independent continence predictor factor in premenopausal patients. Depending on the severity of Incontinence, the higher ICIQ-SF score, the lower TA Ratio or transversus contractility. The TA Ratio was twice in stress Urinary Incontinence (SUI) women compared to those affected by mixed urinary incontinence (MUI). The TA Ratio in MUI women was lower compared to the continent patients. The ultrasound variables in the analyzed sample were modified depending on the birth, the practice of sports, the Body Mass Index and the Oxford score. A continence predictor formula with the ultrasound and epidemiological variables was not possible to define.

Date of Award	21 Jun 2024
Original language	Catalan
Supervisor	Jordi Cassadó Garriga (Director)