title: Football practice and urinary incontinence: Relation between morphology, function and biomechanics.
abstract: Current evidence points to a high prevalence of urinary incontinence among female athletes. In this context, this study aims to assess if structural and biomechanical characteristics of the pubovisceral muscles may lead to urine leakage. Clinical and demographic data were collected, as well as pelvic Magnetic Resonance Imaging. Furthermore, computational models were built to verify if they were able to reproduce similar biomechanical muscle response as the one measured by dynamic imaging during active contraction by means of the percent error. Compared to the continent ones (n=7), incontinent athletes (n=5) evidenced thicker pubovisceral muscles at the level of the midvagina (p=0.019 and p=0.028 for the right and left sides, respectively). However, there were no differences neither in the strength of contraction in the Oxford Scale or in the displacement of the pelvic floor muscles during simulation of voluntary contraction, which suggests that urine leakage may be related with alterations in the intrafusal fibers than just the result of thicker muscles. Additionally, we found similar values of displacement retrieved from dynamic images and numerical models (6.42 ± 0.36 mm vs. 6.10 ± 0.47 mm; p=0.130), with a percent error ranging from 1.47% to 17.20%. However, further refinements in the mechanical properties of the striated skeletal fibers of the pelvic floor muscles and the inclusion of pelvic organs, fascia and ligaments would reproduce more realistically the pelvic cavity.
authors.affiliation: INEGI, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal; Faculty of Sport, University of Porto, Research Centre in Physical Activity, Health and Leisure, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal. Electronic address: thuaneroza@yahoo.com.br.
authors.forename: Thuane Da
authors.initials: TD
authors.lastname: Roza
authors.affiliation: INEGI, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal; Department of Radiology, Centro Hospitalar de São João - EPE, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Sofia
authors.initials: S
authors.lastname: Brandão
authors.affiliation: INEGI, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal.
authors.forename: Dulce
authors.initials: D
authors.lastname: Oliveira
authors.affiliation: Department of Gynecology and Obstetrics, Centro Hospitalar de São João - EPE, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
authors.forename: Teresa
authors.initials: T
authors.lastname: Mascarenhas
authors.affiliation: INEGI, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal.
authors.forename: Marco
authors.initials: M
authors.lastname: Parente
authors.affiliation: Faculty of Sport, University of Porto, Research Centre in Physical Activity, Health and Leisure, Rua Dr. Plácido Costa, 91, 4200-450 Porto, Portugal.
authors.forename: José Alberto
authors.initials: JA
authors.lastname: Duarte
authors.affiliation: INEGI, Faculty of Engineering, University of Porto, Rua Dr Roberto Frias, s/n, 4200-465 Porto, Portugal.
authors.forename: Renato Natal
authors.initials: RN
authors.lastname: Jorge
mesh_terms: D000328:Adult; D056352:Athletes; D001696:Biomechanical Phenomena; D003198:Computer Simulation; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008022:Ligaments / Q000503:physiopathology; D008279:Magnetic Resonance Imaging; D009119:Muscle Contraction; D018485:Muscle Fibers, Skeletal / Q000473:pathology*; D017773:Pelvic Floor / Q000473:pathology*; D010865:Pilot Projects; D012916:Soccer; D014549:Urinary Incontinence / Q000473:pathology* / Q000503:physiopathology; D014621:Vagina / Q000473:pathology; D055815:Young Adult
keywords: Athletes; Finite element method; Magnetic Resonance Imaging; Sports practice; Stress urinary incontinence