University of Ottawa
Research Spotlight
Featured Publications (2)
1) Antônio FI, Yamamoto G, Varette K, McLean L. One in four women with stress urinary incontinence who are taught "the knack" maneuver adopt this motor pattern while coughing: A prospective interventional cohort study. Neurourol Urodyn 2023 Aug;42(6):1290-1298. doi: 10.1002/nau.25196.
This study aimed to evaluate whether women with stress urinary incontinence who receive instruction to perform the knack maneuver perform it during voluntary coughing without specific instruction to do so. Furthermore, it aimed to determine whether subjective and objective stress urinary incontinence outcomes are better among those who perform a knack maneuver during voluntary coughing. This study was a secondary analysis of data acquired from a prospective interventional cohort. Participants received 12 weeks of pelvic floor muscle training including instruction to perform the knack exercise. Performance of the knack before a voluntary cough was confirmed through ultrasound imaging and stress urinary incontinence severity was determined subjectively (International Consultation on Incontinence Modular Questionnaire-Female Lower Urinary Tract Symptoms [ICIQ-FLUTS] overall score, ICIQ-FLUTS UI subscale score, 3-day bladder diary) and objectively (30-min pad test). At baseline, none of the 69 participants performed the knack when asked to cough. At follow-up, more participants performed the knack during a voluntary cough [18/69 (26%), 95% confidence interval [CI] 15%–35%] than at baseline. The extent of improvement in SUI symptoms was not different between participants who did and did not demonstrate the knack during a voluntary cough [FLUTS-UI subscale score (d = 0.31, 95% CI –0.78 to 2.77, n = 69), FLUTS overall score (d = 0.26, 95% CI −1.52–4.23, n = 69), 30-min pad test (d = 0.03, 95% CI −9.35 to 10.32, n = 69), 3-day bladder diary (d = 0.03, 95% CI −4.07 to 3.60, n = 51)]. Approximately one in four women appeared to adopt the knack as a motor response to a cough command, however, adopting the knack was not independently associated with greater improvements in SUI.
Importance: This study highlights the need for providers to explain the benefit of contracting the pelvic floor muscles to prevent urinary leakage, and to ensure patients do these exercises consistently. Furthermore, studies evaluating the long-term benefit of pelvic floor contraction exercises on the pelvic floor may be valuable.
Publications 2024
McLean L, Pulsifer J, Keshwani N, Dumoulin C, Azer N, Lazareck-Devlin A, Dufour S, Sabourin J, Faghani N, Groves V, Cordova L, Sanaee M. CSPM Position Statement: The Landscape of Pelvic Health Physiotherapy in Canada. J Obstet Gynaecol Can 2024 Jul;46(7):102565. doi: 10.1016/j.jogc.2024.102565. Epub 2024 May 29.
Charette M, McLean L. Geographic Accessibility to Pelvic Health Physiotherapy Services Across Ontario: A Geographic Information System Analysis. Physiotherapy Canada 2024 https://doi.org/10.3138/ptc-2023-0114
Horwood G, Flaxman T, McInnes M, McLean L, Singh SS. Ultrasound Elastography in Benign Gynecology: A Scoping Review. Reprod Sci. 2024 Aug;31(8):2508-2522. doi: 10.1007/s43032-024-01535-6.
Camila de Lima Alves da Silva T, da Silva Dantas H, Eduarda Macedo L, Duarte Martins T, Silva-Filho E, Pegado R, McLean L, Thereza Albuquerque Barbosa Cabral Micussi M. Investigating the efficacy of transcranial direct current stimulation on chronic pain management in endometriosis patients: A randomized controlled trial protocol. PLoS One 2024 Aug 1;19(8):e0306405. doi: 10.1371/journal.pone.0306405.
Petter Rodrigues M, Bérubé MÈ, Charette M, McLean L. Conservative interventions for female exercise-induced urinary incontinence: a systematic review. BJU Int 2024 Jul 23. doi: 10.1111/bju.16474.
Clancy A, Stairs J. The effect of subsequent pregnancy and childbirth on stress urinary incontinence recurrence after midurethral sling procedure: a comment. Am J Obstet Gynecol. 2024 Aug;231(2):e76. doi: 10.1016/j.ajog.2024.03.022.
Klahsen O, Thibault-Gagnon S, McLean L. A theoretical model for brisk walking- and running-induced lower urinary tract symptoms (BRUTS) and the development of the BRUTS-questionnaire (BRUTS-Q): A focus group and Delphi study. Neurourol Urodyn 2024 Jul 20. doi: 10.1002/nau.25523.
Coleman CEM, Bonasia K, Pascali D, Clancy A. Complications of obliterative versus reconstructive vaginal surgery for pelvic organ prolapse in octogenarians: A retrospective cohort study. Neurourol Urodynamics 2024 Jun;43(5):1171-1178. doi: 10.1002/nau.25444.
Charette M, Pacheco-Brousseau L, Poitras S, Ashton R, McLean L. Management of urinary incontinence in females by primary care providers: a systematic review. BJU Int 2024 May;133(5):498-512. doi: 10.1111/bju.16234.
Bérubé MÈ, McLean L. The acute effects of running on pelvic floor morphology and function in runners with and without running-induced stress urinary incontinence.
Int Urogynecol J 2024 Jan;35(1):127-138
Publications 2023
Stairs J, Gujral P, Ehlebracht A, van Diepen A, Clancy AA. Women's attitudes towards pessary self-care: a qualitative study. International Urogynecology Journal 2023 Aug;34(8):1899-1906. doi: 10.1007/s00192-023-05472-x
Hamelin A, Pascali D, Leppard J. Just the facts: precipitous deliveries in the emergency department. CJEM. 2023 Oct;25(10):799-801. doi: 10.1007/s43678-023-00552-9.
Bonasia K, Clancy A, Stairs J. Prevalence and risk factors for urinary incontinence up to 2 years postpartum: a cross-sectional population-based study. International Urogynecology Journal. Oct;34(10):2467-2472. doi: 10.1007/s00192-023-05571-9.
Kupfer N, Clancy A, Maguire F, Stairs J. Prevalence and risk factors for urinary incontinence in nulliparous women: a contemporary, population-based cohort study. Urogynecology 2023 May 1;29(5):520-527. doi: 10.1097/SPV.0000000000001296.
Gujral P, Clancy AA. Vesicovaginal Fistula Caused by Complete Procidentia. J Obstet Gynaecol Can 2023 Dec;45(12):101998. doi: 10.1016/j.jogc.2022.07.007
Berube ME, McLean L. Differences in pelvic floor muscle morphology and function between female runners with and without running-induced stress urinary incontinence. Neurourol Urodyn 2023 Nov;42(8):1733-1744. doi: 10.1002/nau.25274
Clancy AA, Ramirez FD. Gender Disparities in Medical Industry Payments. JAMA Surg. 2023 Oct 1;158(10):1112. doi: 10.1001/jamasurg.2023.1667.
Puranda JL, da Silva DF, Edwards CM, Nagpal TS, Souza SCS, Semeniuk K, McLean L, Adamo KB. Characteristics Associated with Pelvic Floor Disorders among Female Canadian Armed Forces Members. J Obstet Gynaecol Can 2023 Sep;45(9):646-654. doi: 10.1016/j.jogc.2023.05.027.
Kanji S, Clancy AA. Stress urinary incontinence and synthetic mesh midurethral slings in women. CMAJ. 2023 Aug 21;195(32):E1082. doi: 10.1503/cmaj.221592.
Antônio FI, Yamamoto G, Varette K, McLean L. One in four women with stress urinary incontinence who are taught "the knack" maneuver adopt this motor pattern while coughing: A prospective interventional cohort study. Neurourol Urodyn 2023 Aug;42(6):1290-1298. doi: 10.1002/nau.25196.
Bouchard ME, Stairs J, Hickling D, Clancy A, Khalil H. The use of tissue adhesive in management of genitourinary fistulas: a systematic review and case report. Int Urogynecol J 2023 Feb;34(2):445-451. doi: 10.1007/s00192-022-05297-0.
Dufour S, Clancy A, Wu M. Technical Update No. 433: eHealth Solutions for Urinary Incontinence Among Women. J Obstet Gynaecol Can 2023 Feb;45(2):150-159.e1. doi: 10.1016/j.jogc.2022.10.005. Epub 2022 Oct 21.
Publications 2022 (additional)
Wuebbolt D, Bouchard ME, Hussein S, Pascali D, Clancy AA. Complications Following Posterior Colporrhaphy With and Without Anal Sphincteroplasty: An Analysis of Cases in the National Surgical Quality Improvement Program Database. J Obstet Gynaecol Can 2022 Dec;44(12):1257-1261. doi: 10.1016/j.jogc.2022.10.011.
Bouchard ME, Baker K, Schachter J, Khalil H, Pascali D, Hickling D, Clancy A. Preoperative anemia and complications after surgery for pelvic organ prolapse: an analysis of the national surgical quality improvement program database. Int Urogynecol J. 2022 Jul;33(7):1827-1831. doi: 10.1007/s00192-021-04800-3.
McLean L, Charette M, Varette K, Brooks K, Harvey MA, Robert M, Baker K, Day A, Della Zazzera V, Sauerbrei E, Brison R. Pelvic floor muscle training as an adjunct to a midurethral sling: a single-blind randomised controlled trial. Int Urogynecol J. 2022 Apr;33(4):809-819. doi: 10.1007/s00192-020-04668-9. Epub 2021 Mar 3. PMID: 33660001.
Stairs J, Clancy AA. Letter to the Editor: Hysterectomy Versus Uterine Preservation at the Time of Pelvic Reconstructive Surgery. J Obstet Gynaecol Can 2022 Sep;44(9):951. doi: 10.1016/j.jogc.2022.06.001.
McLean L, Reeves J. RE: The article entitled "Effect of footwear on intramuscular EMG activity of plantar flexor muscles in walking" by Péter, A., Arndt, A., Hegyi, A., Finni, T., Andersson, E., Alkjaer, T., Tarassova, O., Ronquist, G., Cronin, N J Electromyogr Kinesiol 2022 Jun:64:102661. doi: 10.1016/j.jelekin.2022.102661. Epub 2022 Apr 16.
McLean L, Hickling D. Reply to "Androgen deficiency and stress urinary incontinence" Int Urogynecol J 2022 May;33(5):1355-1356. doi: 10.1007/s00192-022-05161-1.
2) McLean L, Charette M, Varette K, Brooks K, Harvey MA, Robert M, Baker K, Day A, Della Zazzera V, Sauerbrei E, Brison R. Pelvic floor muscle training as an adjunct to a midurethral sling: a single-blind randomised controlled trial. Int Urogynecol J. 2022 Apr;33(4):809-819. doi: 10.1007/s00192-020-04668-9. Epub 2021 Mar 3. PMID: 33660001.
This was a single-blind randomised controlled trial comparing peri-operative physiotherapist-supervised pelvic floor muscle training versus receiving a pelvic floor muscle therapy handout. Efficacy on stress urinary incontinence (SUI) symptoms improvement and other urinary symptoms was assessed. Women with SUI planning mid-urethral sling insertion (N=103) were randomized to one of the 2 arms and followed for 3 months after the surgery; they were recontacted at up to 2 years. Women in the physiotherapy group (N=52) participated in 6 physiotherapist-led sessions over 12 weeks preoperatively, as well as 3 postoperative sessions, while the control group (N=51) received standard recommendations by handout. At 3 months postoperatively, all participants in both groups show improvement compared to baseline. The physiotherapy group reported better improvement in SUI symptoms and higher cure at 3 months postoperatively than the control group. However, no difference between groups was found on pad test, filling or voiding symptoms. Fifty-two women attended 1-year follow-up and 36 completed 2-year follow-up, with overall results similar to 3 months. It was concluded that a postoperative physiotherapist-led program of pelvic floor muscle training was more effective than providing handouts for SUI cure at 3 months postoperatively. Larger longer-term studies are needed.
2021-2022 Publication List
Stairs J, Rolnik D, Pascali D, Clancy A. Association between obstetrical anal sphincter injury and postpartum urinary retention: a contemportary nationwide cohort study. International Urogynecology Journal 2022. (epub ahead of print, doi: 10.1007/s00192-022-05346-8).
Xia W, Ameri G, Fakim D, Akhuanzada H, Raza MZ, Abbas Shobeiri S, McLean L, Chen ECS. Automatic plane of minimal hiatal dimensions extraction from 3D female pelvic floor ultrasound. IEEE Trans Med Imaging. 2022 Aug 19;PP. doi: 10.1109/TMI.2022.3199968. Epub ahead of print. PMID: 35984794.
Arranz-Martín B, Navarro-Brazález B, Sánchez-Sánchez B, McLean L, Carazo-Díaz C, Torres-Lacomba M. The Impact of Hypopressive Abdominal Exercise on Linea Alba Morphology in Women Who Are Postpartum: A Short-Term Cross-Sectional Study. Phys Ther. 2022 Aug 4;102(8):pzac086. doi: 10.1093/ptj/pzac086. PMID: 35908286.
Niederauer S, Bérubé MÈ, Brennan A, McLean L, Hitchcock R. Pelvic floor tissue damping during running using an intra-vaginal accelerometry approach. Clin Biomech (Bristol, Avon). 2022 Feb;92:105554. doi: 10.1016/j.clinbiomech.2021.105554. Epub 2021 Dec 29. PMID: 34974336; PMCID: PMC8863648.
Bernard S, McLean L, Boucher S, Hébert LJ, Plante M, Grégoire J, Sebastianelli A, Renaud MC, Froment MA, Moffet H. An in-home rehabilitation program for the treatment of urinary incontinence symptoms in endometrial cancer survivors: a single-case experimental design study. Int Urogynecol J. 2021 Nov;32(11):2947-2957. doi: 10.1007/s00192-021-04981-x. Epub 2021 Sep 25. PMID: 34562132; PMCID: PMC8536558.
Antônio FI, Rodrigues MP, Brooks K, Varette K, McLean L. What improvements in levator ani motor function lead to improvement in stress urinary incontinence signs and symptoms in females? Int Urogynecol J. 2022 Oct;33(10):2735-2747. doi: 10.1007/s00192-021-04931-7. Epub 2021 Sep 3. PMID: 34477898.
Bouchard ME, Stairs J, Hickling D, Clancy A, Khalil H. The use of tissue adhesive in management of genitourinary fistulas: a systematic review and case report. International Urogynecology Journal 2022. (epub ahead of print, doi: 10.1007/s00192-022-05297-0).
Gujral P, Clancy AA. Vesicovaginal fistula caused by complete procidentia. Journal of Obstetrics and Gynecology of Canada 2022; S1701-2163(22)00471-6. (epub ahead of print, doi: 10.1016/j.jogc.2022.07.007).
Brooks KCL, Varette K, Harvey MA, Robert M, Brison RJ, Day A, Baker K, Della Zazzera V, Sauerbrei E, McLean L. A model identifying characteristics predictive of successful pelvic floor muscle training outcomes among women with stress urinary incontinence. Int Urogynecol J. 2021 Mar;32(3):719-728.
Kanji S, Pascali D, Clancy AA. Short term complications in mesh augmented vaginal repair of pelvic organ prolapse are not higher when compared with native tissue repair. Int Urogynecol J. 2022, 33(7):1941-1947. (epub ahead of print, doi: 10.1007/s00192-021-04915-7).
Bouchard ME, Baker K, Schachter J, Khalil H, Pascali D, Hickling D, Clancy A. Preoperative anemia and complications after surgery for pelvic organ prolapse: an analysis of the national surgical quality improvement program database. Int Urogynecol J. 2021; (epub ahead of print, doi: 10.1007/s00192-021-04800-3).
Stairs J, Minassian V, Clancy A. Complications after vaginal vault suspension versus minimally invasive sacrocolpopexy in women with elevated body mass index: A retrospective cohort study using data from the national surgical quality improvement program database. Female Pelvic Med Reconstr Surg 2022, 28(6):391-396.
Nayak AL, Breau R, Hickling D, Pascali D, Clancy A, Mallick R, Chen I. Risk Factors for Urologic Injury in Women Undergoing Hysterectomy for Benign Indication. J Obstet Gynaecol Can. 2022, 44(3):247-254.
Reeves J, McLean L. The influence of contraction type, prior performance of a maximal voluntary contraction and measurement duration on fine-wire EMG amplitude. J Electromyogr Kinesiol. 2021 Aug;59:102566. doi: 10.1016/j.jelekin.2021.102566. Epub 2021 Jun 8. PMID: 34139549.
Bernard S, Frenette AG, McLean L, Noël P, Froment MA, Hébert LJ, Moffet H. Reliability of ultrasound imaging of pelvic floor morphology and function among females who have undergone pelvic radiotherapy. Neurourol Urodyn. 2021 Apr;40(4):1001-1010. doi: 10.1002/nau.24656. Epub 2021 Mar 19. PMID: 33739537.
McLean L, Charette M, Varette K, Brooks K, Harvey MA, Robert M, Baker K, Day A, Della Zazzera V, Sauerbrei E, Brison R. Pelvic floor muscle training as an adjunct to a midurethral sling: a single-blind randomised controlled trial. Int Urogynecol J. 2022 Apr;33(4):809-819. doi: 10.1007/s00192-020-04668-9. Epub 2021 Mar 3. PMID: 33660001.
Falah-Hassani K, Reeves J, Shiri R, Hickling D, McLean L. The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. Int Urogynecol J. 2021 Mar;32(3):501-552. doi: 10.1007/s00192-020-04622-9. Epub 2021 Jan 8. Erratum in: Int Urogynecol J. 2021 Jun;32(6):1607. PMID: 33416968; PMCID: PMC8053188.
Czyrnyj CS, Bérubé MÈ, Lanteigne E, Brennan A, Bader Y, Lomovtsev D, Vandermolen M, Boucher S, Mitri L, McLean L. Design and validation of an automated dual-arm instrumented intravaginal dynamometer. Neurourol Urodyn. 2021 Feb;40(2):604-615. doi: 10.1002/nau.24600. Epub 2021 Jan 7. PMID: 33410542.
Padoa A, McLean L, Morin M, Vandyken C. The Overactive Pelvic Floor (OPF) and Sexual Dysfunction. Part 2: Evaluation and Treatment of Sexual Dysfunction in OPF Patients. Sex Med Rev. 2021 Jan;9(1):76-92. doi: 10.1016/j.sxmr.2020.04.002. Epub 2020 Jul 4. PMID: 32631813.
Clancy AA, Ilin J, Shehata F, Pascali D, Hickling D. Outcomes of an overnight-stay unit for urogynecologic surgery: feasibility and risk factors for failure of next-day discharge. Female Pelvic Med Reconstr Surg 2021,1;27(2):98-104.
Clancy AA, Chen I, Pascali D, Minassian V. Surgical approach and unplanned readmission following pelvic organ prolapse surgery: a retrospective cohort study using data from the National Surgical Quality Improvement Program (NSQIP). Int Urogynecol J. 2021, 32(4): 945-953.
Shehata F, Hickling D, Pascali D. Urethral erosion of an obturator midurethral sling. J Obstet Gynaecol Can. 2021, 43(4):423.