Pan J. et al., 2021: Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review

Pan J, Liang E, Cai Q, Zhang D, Wang J, Feng Y, Yang X, Yang Y, Tian W, Quan C, Han R, Niu Y, Chen Y, Xin Z.
Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.
Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China.
Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Andrology Center, Peking University First Hospital, Peking University, Beijing, China.

Abstract

With the increasing prevalence of obesity worldwide, obesity-related female stress urinary incontinence (FSUI) has become a key health problem. Recent studies indicated that FSUI is primarily caused by obesity-related pathological changes, such as fat droplet deposition, and results in pelvic floor nerve, vascular, and urethral striated muscle injury. Meanwhile, treatments for obesity-associated FSUI (OA-FSUI) have garnered much attention. Although existing OA-FSUI management strategies, including weight loss, pelvic floor muscle exercise, and urethral sling operation, could play a role in symptomatic relief; they cannot reverse the pathological changes in OA-FSUI. The continued exploration of safe and reliable treatments has led to regenerative therapy becoming a particularly promising area of researches. Specifically, micro-energy, such as low-intensity pulsed ultrasound (LIPUS), low-intensity extracorporeal shock wave therapy (Li-ESWT), and pulsed electromagnetic field (PEMF), have been shown to restore the underlying pathological changes of OA-FSUI, which might be related by regulation endogenous stem cells (ESCs) to restore urine control function ultimately in animal experiments. Therefore, ESCs may be a target for repairing pathological changes of OA-FSUI. The aim of this review was to summarize the OA-FSUI-related pathogenesis, current treatments, and to discuss potential therapeutic options. In particular, this review is focused on the effects and related mechanisms of micro-energy therapy for OA-FSUI to provide a reference for future basically and clinical researches.
Transl Androl Urol. 2021 Jan;10(1):494-503. doi: 10.21037/tau-20-1217. PMID: 33532337 Review. FREE ARTICLE