Mp23-09 Pathophysiologic Mechanisms of Urinary Incontinence in Nulliparous Female Elite Athletes: A Cross-Sectional Study Using Dynamic Pelvic Magnetic Resonance Imaging

You have accessJournal of UrologyUrodynamics/Lower Urinary Tract Dysfunction/Female Pelvic Medicine: Female Incontinence (MP23)1 May 2024MP23-09 PATHOPHYSIOLOGIC MECHANISMS OF URINARY INCONTINENCE IN NULLIPAROUS FEMALE ELITE ATHLETES: A CROSS-SECTIONAL STUDY USING DYNAMIC PELVIC MAGNETIC RESONANCE IMAGING Zoe S. Gan, Karthik Sundaram, and Ariana L. Smith Zoe S. GanZoe S. Gan , Karthik SundaramKarthik Sundaram , and Ariana L. SmithAriana L. Smith View All Author Informationhttps://doi.org/10.1097/01.JU.0001008776.99097.8a.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary incontinence is common in young, nulliparous female elite athletes, but the effects of high-intensity exercise on the pelvic floor are not well understood. Our objective was to perform an exploratory study in this population to examine urinary symptoms and associated pelvic floor anatomy and function. We hypothesized that symptomatic athletes would exhibit pelvic floor descent with urethral hypermobility and compensatory hypertrophy of levator ani muscles, while asymptomatic athletes would not. METHODS: We performed a cross-sectional study of National Collegiate Athletic Association Division 1 nulliparous female athletes comparing symptomatic (i.e. currently or previously experienced urinary leakage during exercise) and asymptomatic athletes. Athletes underwent pelvic exam and pelvic MRI assessing the pelvic floor at rest and at maximal strain. We also assessed demographics, sport characteristics, relevant medical history, and validated genitourinary symptom questionnaires (Lower Urinary Tract Dysfunction Network Symptom Index-29, LURN SI-29; Female Genitourinary Pain Index, GUPI). Data were compared between groups using the Wilcoxon rank sum, Pearson Chi-square, and Fisher exact tests as appropriate. RESULTS: A total of 29 athletes (11 asymptomatic, 18 symptomatic) participated. Demographics, sport characteristics, and pelvic exam findings were similar between groups. Compared to asymptomatic athletes, symptomatic athletes had significantly worse overall urinary symptoms (median LURN SI-29 8.5 vs. 8, p=0.02) and genitourinary pain (median GUPI 7 vs. 3, p=0.04). Symptomatic athletes had greater thickness of both the striated muscle of the urethral sphincter (2.5 mm vs. 1.8 mm, p=0.02) and pubovisceral and levator ani muscles (10.3 mm vs. 8.7 mm, p=0.04) on MRI. Although not statistically significant, symptomatic athletes had more hiatal enlargement and pelvic floor descent, urethral hypermobility, bladder neck funneling during Valsalva, abnormalities of the paraurethral and pubourethral ligaments, shorter urethral length, and lower median Brink score on pelvic exam. CONCLUSIONS: This pilot study demonstrates feasibility of a dynamic pelvic MRI protocol in nulliparous female elite athletes. Athletes with UI have several anatomic and functional differences in the pelvic floor compared to asymptomatic athletes, which may be intrinsic or acquired. Longitudinal assessment will be required to identify modifiable risk factors and potential interventions. Source of Funding: University of Pennsylvania Health System (Department of Radiology Protocol Development Funding, Division of Urology, Department of Surgery) © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e384 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zoe S. Gan More articles by this author Karthik Sundaram More articles by this author Ariana L. Smith More articles by this author Expand All Advertisement PDF downloadLoading ...