Relationship Between Pudendal Nerve Conduction Rate And SUI In Postpartum Women

Objective:Stress Urinary Incontinence(SUI)is a common dysfunction of the pel-vic floor that affects women’s health,with an overall prevalence of 18.9%among Chi-nese women.Because high risk factors such as pregnancy and childbirth can result in pathophysiological changes to nerves,muscle and ligament of the pelvic floor,the inci-dence can be 16.3%to 23.8%in postpartum women and 21%in foreign countries.The vast majority of SUI is anatomic stress incontinence,it is rarely due to disorders of the internal urethral sphincter,and therefore research into the anatomic pathogenesis of SUI is the most advantageous direction for the prevention and early treatment of this condi-tion.Research into the anatomic pathogenesis of SUI is thus the most beneficial direc-tion for the prevention and early treatment of this condition.The pudendal nerve(PN)is the nerve most closely associated with pelvic floor function,particularly the mainte-nance of normal physiological muscle function,and damage to the PN directly impairs the performance of pelvic floor functions such as voiding,defecation and sexual func-tion.One of the primary tools for measuring pudendal nerve electrophysiology is the nerve conduction velocity of the pudendal nerve.To complement this technique,the pudendal nerve innervating the pelvic floor-related muscles is stimulated in order to an-alyze the integrity of the nerve conduction pathway,and collection of nerve conduction time to detect the rapid and slow rate of conduction of movement.In order to under-stand the correlation between nerve conduction velocity and SUI in postnatal women,and to provide a theoretical basis for clinical diagnosis and to better restore the quality of life of women with postpartum SUI through the detection of pudendal nerve injury status in SUI,which is of great practical importance.Materials and Methods:We recruited women who were attending the Female Pelvic Floor Urological Rehabilitation Center of Dalian Women and Children’s Medical Center Group Sports New City Campus during the period March 2022 to October 2022,who ranged in age from twenty to thirty-five,who had never undergone pelvic floor treatment or surgery prior to pregnancy,and who were able The study was carried out in50 cases each in the normal postnatal group(non-SUI group)and in the SUI group.Nerve conduction testing was performed on all subjects using the French PHENIX USB8 nerve conduction velocity function module and baseline obstetric data,pelvic floor ultrasound,and muscle strength and other ancillary examinations were also collected.Results:The nerve conduction time(4.30±2.69ms vs 2.13±2.05ms,P<0.001)and the current intensity of the required stimulation(6.61±1.81m A vs 5.58±1.51m A,P=0.003)were greater in the SUI group than in the non-SUI group,indicatin g that the SUI group required stronger peripheral nerve current stimulation than the non-SUI group,the nerve conduction The SUI group required more intense peripheral nerve current stimulation,longer nerve conduction time,slower nerve conduction rate,and more severe pudendal nerve injury than the non-SUI group.When comparing the basic obstetric data of the two groups,the BMI of the SUI group(25.79±3.31kg/m~2 vs 23.33±3.41kg/m~2,P=0.001)was greater than that of the non-SUI group,and the difference was statistically significant,while the rest of the basic obstetric data were not significantly different.When comparing the data of the two groups of pelvic floor ultrasound and muscle strength and other auxiliary examinations,the bladder neck downward distance(ΔBND)(18.19±7.49mmvs 11.05±6.80mm,P<0.001),bladder downward distance(ΔBSD)(20.91±8.98mm vs 13.64±8.96mm,P<0.001),anterior-posterior genital tract fissure diameter(62.34±9.37mm vs 57.16±9.28mm,P=0.007),the angle of inclination of the inferior urethra of Valsalva(41.89±24.27 vs 22.52±18.41,P<0.001),and the posterior angle of the inferior bladder of Valsalva(171.02±32.17 vs 152.92±33.65,P=0.009)were greater than in the non-SUI group,and the rest of the data from ancill ary tests such as pelvic floor ultrasound and muscle strength were not significant ly different.Multifactorial analysis showed that nerve conduction time(OR=1.628,95%CI:1.242-2.133),body mass index(OR=1.262,95%CI:1.094-1.457),bladder neck downward distance(OR=1.151,95%CI:1.069-1.239),urethral tilt angle(OR=1.029,95%CI:1.011-1.047),posterior bladder angle(OR=1.017,95%CI:1.004-1.031)were risk factors for the development of SUI,and nerve conduction time was associated with body mass index(BMI)(r=0.284,P=0.005),anterior-posterior diameter of the resting genital tract fissure(r=0.234,P=0.022),Valsalva(r=0.213,P=0.038),and no significant correlation with the remaining indicators.Conclusion:The prolonged pudendal nerve conduction time and slower nerve conduction rate in patients with postpartum SUI indicate the presence of damage to the pudendal nerves already present in SUI patients to varying degrees,suggests that the theory of neurogenic injury may be a factor in the pathogenesis of stress urinary incon-tinence.Pudendal nerve injury,obesity,bladder neck downward distance,urethral tilt angle,and posterior bladder angle are risk factors for the development of SUI.