{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T16:56:57Z","timestamp":1780678617655,"version":"3.54.1"},"reference-count":43,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Upright open magnetic resonance imaging allows the impact of posture and gravity to be evaluated. Randomized controlled trials of yoga for treating urinary incontinence (UI) in women show significant clinical benefit, yet the anatomic impact of this therapy on the lower urinary tract remains unelucidated. This study tested the hypothesis that open MRI scans can be obtained with sufficient detail to visualize the bladder neck and urethra. Methods: We scanned a volunteer subject using a 0.5 Tesla MRO Open Evo scanner to obtain axial and sagittal T2-weighted pelvic scans during poses used in yoga therapy. To obtain images with the necessary detail, we employed variations in sequencing during scanning of each individual pose. The changes observed in the bladder neck and urethral outline in each pose were then compared to baseline supine images. Results: Images with sufficient anatomic detail were obtained in each of the four poses studied. These scans identified that the urethral outline changes anatomically based on the posture adopted and is dynamic with regional alternations evident in caliber during specific yoga poses. Conclusions: Open MRI can identify anatomical changes involving the bladder neck and urethra that occur during yoga poses used in the treatment of UI in women; these likely relate to effects of posture and gravity. Open MRI offers a way to elucidate the anatomic effects that specific yoga poses generate and to identify those with the potential to be most beneficial clinically to women as a form of therapy.<\/jats:p>","DOI":"10.3390\/diagnostics15060723","type":"journal-article","created":{"date-parts":[[2025,3,14]],"date-time":"2025-03-14T04:29:18Z","timestamp":1741926558000},"page":"723","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Upright Open MRI (MRO) Evaluation of the Anatomic Effects of Yoga Postures on the Bladder Neck and Urethra"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8583-2986","authenticated-orcid":false,"given":"Andrew","family":"Macnab","sequence":"first","affiliation":[{"name":"Departments of Urology and Pediatrics, University of British Columbia, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada"},{"name":"Stellenbosch Institute for Advanced Study, Wallenberg Research Centre, Stellenbosch 7600, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn","family":"Stothers","sequence":"additional","affiliation":[{"name":"Division of Urogynecology and Reconstructive Pelvic Surgery, Department of Urology, University of California, 200 UCLA, Medical Plaza #140, Los Angeles, CA 90095, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00586-017-5304-3","article-title":"Current concept in upright spinal MRI","volume":"27","author":"Botchu","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1002\/1520-6777(2001)20:2<167::AID-NAU19>3.0.CO;2-4","article-title":"Dynamic MRI of the pelvic floor muscles in an upright sitting position","volume":"20","author":"Talseth","year":"2001","journal-title":"Neurourol. Urodyn."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"E453","DOI":"10.5489\/cuaj.5186","article-title":"Relevance of open magnetic resonance imaging position (sitting and standing) to quantify pelvic organ prolapse in women","volume":"12","author":"Abdulaziz","year":"2018","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"197","DOI":"10.5489\/cuaj.2767","article-title":"Positional pelvic organ prolapse (POP) evaluation using open, weight-bearing magnetic resonance imaging (MRI)","volume":"9","author":"Friedman","year":"2015","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_5","first-page":"CD012668","article-title":"Yoga for treating urinary incontinence in women","volume":"2","author":"Wieland","year":"2019","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1001\/jama.300.11.1311","article-title":"Prevalence of symptomatic pelvic floor disorders in US women","volume":"300","author":"Nygaard","year":"2008","journal-title":"JAMA"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"320","DOI":"10.1016\/j.explore.2019.04.005","article-title":"Yoga for Treating Urinary Incontinence in Women: Commentary on a Cochrane Review","volume":"15","author":"Bethel","year":"2019","journal-title":"Explore"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"87.e1","DOI":"10.1016\/j.ajog.2018.10.031","article-title":"A group-based yoga program for urinary incontinence in ambulatory women: Feasibility, tolerability, and change in incontinence frequency over 3 months in a single-center randomized trial","volume":"220","author":"Huang","year":"2019","journal-title":"Am. J. Obs. Gynecol."},{"key":"ref_9","first-page":"141","article-title":"Comparison of mindfulness-based stress reduction versus yoga on urinary urge incontinence: A randomized pilot study. with 6-month and 1-year follow-up visits","volume":"20","author":"Baker","year":"2014","journal-title":"Urogynecology"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Nicosia, F.M., Lisha, N.E., Chesney, M.A., Subak, L.L., Plaut, T.M., and Huang, A. (2020). Strategies for evaluating self-efficacy and observed success in the practice of yoga postures for therapeutic indications: Methods from a yoga intervention for urinary incontinence among middle-aged and older women. BMC Complement. Med. Ther., 20.","DOI":"10.1186\/s12906-020-02934-3"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1016\/j.juro.2015.01.062","article-title":"Re: A group-based yoga therapy intervention for urinary incontinence in women: A pilot randomized trial","volume":"193","author":"Wein","year":"2015","journal-title":"J. Urol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1097\/JU.0000000000001207.02","article-title":"Re: A Group-Based Yoga Program for Urinary Incontinence in Ambulatory Women: Feasibility, Tolerability, and Change in Incontinence Frequency over 3 Months in a Single-Center Randomized Trial","volume":"204","author":"Griebling","year":"2020","journal-title":"J. Urol."},{"key":"ref_13","unstructured":"(2024, November 22). Yoga: What You Need to Know. National Center for Complementary and Integrative Health. Updated August 2023, Available online: https:\/\/www.nccih.nih.gov\/health\/yoga-what-you-need-to-know."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1093\/aje\/kwv071","article-title":"The Safety of Yoga: A Systematic Review and Meta-Analysis of Randomized Controlled Trials","volume":"182","author":"Cramer","year":"2015","journal-title":"Am. J. Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1089\/acm.2018.0382","article-title":"Yoga\u2019s biophysiological effects on lower urinary tract symptoms: A scoping review","volume":"25","author":"Sha","year":"2019","journal-title":"J. Altern. Complement. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"101768","DOI":"10.1016\/j.ctcp.2023.101768","article-title":"The relative activation of pelvic floor muscles during selected yoga poses","volume":"52","author":"Blagg","year":"2023","journal-title":"Complement. Ther. Clin. Pract."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1002\/jmri.1880060622","article-title":"MR imaging of the female pelvic floor in the supine and upright positions","volume":"6","author":"Fielding","year":"1996","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1007\/s00192-015-2790-x","article-title":"MRI of female urethra and periurethral pathologies","volume":"27","author":"Itani","year":"2016","journal-title":"Int. Urogynecol. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1148\/radiol.2232010665","article-title":"Dynamic MR imaging of the pelvic floor performed with patient sitting in an open-magnet unit versus with patient supine in a closed-magnet unit","volume":"223","author":"Bertschinger","year":"2002","journal-title":"Radiology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1097\/OGX.0b013e3181e5a0a6","article-title":"Dynamic magnetic resonance imaging of the behavior of the mid-urethra in healthy and stress incontinent women","volume":"65","author":"Rinne","year":"2010","journal-title":"Obstet. Gynecol. Surv."},{"key":"ref_21","first-page":"269","article-title":"Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence","volume":"68","author":"Kohorn","year":"1986","journal-title":"Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1007\/BF02199565","article-title":"Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography","volume":"9","author":"Dietz","year":"1998","journal-title":"Int. Urogynecol. J."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1002\/nau.1004","article-title":"Pelvic muscle activity in nulliparous volunteers","volume":"20","author":"Peschers","year":"2001","journal-title":"Neurourol. Urodyn."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s001920170090","article-title":"Evaluation of pelvic floor muscle strength using four different techniques","volume":"12","author":"Peschers","year":"2001","journal-title":"Int. Urogyn. J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1016\/0029-7844(94)00369-O","article-title":"Perineal ultrasound for evaluating the bladder neck in urinary stress incontinence","volume":"85","author":"Schaer","year":"1995","journal-title":"Obstet. Gynecol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1007\/s00192-015-2916-1","article-title":"What is normal bladder neck anatomy?","volume":"27","author":"Shek","year":"2016","journal-title":"Int. Urogyn. J."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Horosz, E., Pomian, A., Zwierzchowska, A., Lisik, W., Majkusiak, W., Tomasik, P., Rutkowska, B., Skalska, J., Siemion, M., and Banasiuk, D. (2020). Epidemiological features of the bladder neck rest position and mobility. J. Clin. Med., 9.","DOI":"10.3390\/jcm9082413"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"81","DOI":"10.3233\/BSI-180178","article-title":"Methodology for 3D image reconstruction of the female pelvis from upright open MRI (MRO) 2D imaging","volume":"7","author":"Abdulaziz","year":"2018","journal-title":"Biomed. Spectrosc. Imaging"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.ejogrb.2005.10.018","article-title":"MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence","volume":"126","author":"Tunn","year":"2006","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1607","DOI":"10.2214\/ajr.171.6.9843296","article-title":"MR imaging of pelvic floor continence mechanisms in the supine and sitting positions","volume":"171","author":"Fielding","year":"1998","journal-title":"Am. J. Roentgenol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1007\/PL00004030","article-title":"The influence of posture on perineal ultrasound imaging parameters","volume":"12","author":"Dietz","year":"2001","journal-title":"Int. Urogynecol. J."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jphys.2021.12.011","article-title":"Pelvic floor muscle function differs between supine and standing positions in women with stress urinary incontinence: An experimental crossover study","volume":"68","author":"Gimenez","year":"2022","journal-title":"J. Physiother."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1007\/s00192-004-1125-0","article-title":"Pelvic floor muscle training is effective in treatment of female stress urinary incontinence, but how does it work?","volume":"15","year":"2004","journal-title":"Int. Urogynecol. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1007\/s00192-020-04622-9","article-title":"The pathophysiology of stress urinary incontinence: A systematic review and meta-analysis","volume":"32","author":"Reeves","year":"2021","journal-title":"Int. Urogynecol. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.1002\/nau.22370","article-title":"Effects of PFM rehabilitation on PFM function and morphology in older women","volume":"32","author":"Madill","year":"2013","journal-title":"Neurourol. Urodyn."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"B\u00f8, K., Berghmans, B., M\u00f8rkved, S., and Van Kampen, M. (2015). Pelvic floor dynamometry. Evidence-Based Physical Therapy for the Pelvic Floor: Bridging Science and Clinical Practice, Elsevier Health Sciences. [2nd ed.].","DOI":"10.1016\/B978-0-7020-4443-4.00001-7"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S1836-9553(13)70180-2","article-title":"There is not yet strong evidence that exercise regimens other than pelvic floor muscle training can reduce stress urinary incontinence in women: A systematic review","volume":"59","author":"Herbert","year":"2013","journal-title":"J. Physiother."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"155","DOI":"10.7600\/jpfsm.12.155","article-title":"Investigation of effective standing posture for increasing activity of pelvic floor muscles: A cross-sectional study","volume":"12","author":"Ishihara","year":"2023","journal-title":"J. Phys. Fit. Sports Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1080\/01443610701327487","article-title":"Ambulatory urodynamic monitoring: Are we wasting our time?","volume":"27","author":"Patravali","year":"2007","journal-title":"J. Obstet. Gynaecol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.gtc.2008.06.003","article-title":"Pelvic floor anatomy and applied physiology","volume":"37","author":"Raizada","year":"2008","journal-title":"Gastroenterol. Clin. N. Am."},{"key":"ref_41","first-page":"4","article-title":"Effects of Isha Hatha Yoga on Core Stability and Standing Balance","volume":"30","author":"Kumar","year":"2016","journal-title":"Adv. Mind Body Med."},{"key":"ref_42","first-page":"57","article-title":"Yoga for women with urgency urinary incontinence: A pilot study","volume":"27","author":"Tenfelde","year":"2021","journal-title":"Urogynecology"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"101502","DOI":"10.1016\/j.ctcp.2021.101502","article-title":"Yoga and Pilates compared to pelvic floor muscle training for urinary incontinence in elderly women: A randomised controlled pilot trial","volume":"46","author":"Kannan","year":"2022","journal-title":"Complement. Ther. Clin. Pract."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/723\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:53:21Z","timestamp":1760028801000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/6\/723"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,13]]},"references-count":43,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diagnostics15060723"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15060723","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,13]]}}}