Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review

Jiancheng Pan; Enli Liang; Qiliang Cai; Dingrong Zhang; Jiang Wang; Yuhong Feng; Xiaoqing Yang; Yongjiao Yang; Wenjie Tian; Changyi Quan; Ruifa Han; Yuanjie Niu; Yegang Chen; Zhongcheng Xin

doi:10.21037/tau-20-1217

Progress in studies on pathological changes and future treatment strategies of obesity-associated female stress urinary incontinence: a narrative review

Transl Androl Urol. 2021 Jan;10(1):494-503. doi: 10.21037/tau-20-1217.

Authors

Jiancheng Pan^{1

2}, Enli Liang^{1

2}, Qiliang Cai^{1

2}, Dingrong Zhang^{1

2}, Jiang Wang^{1

2}, Yuhong Feng^{1

2}, Xiaoqing Yang^{1

2}, Yongjiao Yang^{1

2}, Wenjie Tian³, Changyi Quan^{1

2}, Ruifa Han^{1

2}, Yuanjie Niu^{1

2}, Yegang Chen^{1

2}, Zhongcheng Xin^{1

2

4}

Affiliations

¹ Male Reproductive and Sexual Medicine, Department of Urology, the Second Hospital of Tianjin Medical University, Tianjin, China.
² Laboratory of Male Reproductive Medicine, Tianjin Urology Institute, Tianjin, China.
³ Department of Urology, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
⁴ 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.

Keywords: Obesity-associated female stress urinary incontinence (OA-FSUI); endogenous stem cells (ESCs); low-intensity extracorporeal shock wave therapy (Li-ESWT); low-intensity pulsed ultrasound (LIPUS); pathology; regeneration.

Publication types

Review