{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T07:20:59Z","timestamp":1761895259310,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T00:00:00Z","timestamp":1761782400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Postoperative urinary retention (POUR) occurs in 10\u201315% of women after surgical procedures for stress urinary incontinence (SUI). Guarding Reflex Inhibition Training (GRIT) is a novel behavioral approach that teaches patients to consciously inhibit involuntary pelvic floor contraction. We evaluated whether preoperative GRIT is associated with decreased POUR after urethral bulking with polyacrylamide hydrogel (PAHG). Methods: We performed a retrospective review of 145 women with SUI. Perioperative care was consistent across groups, separated by date of service; only those treated after November 2023 received structured GRIT instruction. The primary outcome was POUR, defined as the need for &gt;1 episode of straight catheterization or discharge with a catheter. Results: POUR occurred in 15\/106 (14.2%) patients without GRIT and 0\/39 (0%) patients with GRIT. This difference was statistically significant (Fisher\u2019s exact test p = 0.012), corresponding to an absolute risk reduction of 14.2% (95% CI: 4.8\u201323.9) and a number needed to treat (NNT) of 7. Post hoc power was &gt;90%. Conclusions: Preoperative GRIT, a novel and reproducible training paradigm, was associated with a reduction in POUR following urethral bulking. By targeting conscious inhibition of the guarding reflex, GRIT highlights the potential for integrating behavioral retraining with procedural therapy across incontinence interventions.<\/jats:p>","DOI":"10.3390\/jcm14217701","type":"journal-article","created":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:28:43Z","timestamp":1761888523000},"page":"7701","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Guarding Reflex Inhibition Training Reduces Postoperative Urinary Retention After Urethral Bulking for Stress Urinary Incontinence: A Retrospective Single-Center Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5826-9490","authenticated-orcid":false,"given":"Nicole","family":"Fleischmann","sequence":"first","affiliation":[{"name":"White Plains Hospital Center, 41 East Post Road, White Plains, NY 10601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlena","family":"Plagianos","sequence":"additional","affiliation":[{"name":"Montefiore\/Albert Einstein College of Medicine, 1825 Eastchester Rd, Bronx, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"Meiselman","sequence":"additional","affiliation":[{"name":"White Plains Hospital Center, 41 East Post Road, White Plains, NY 10601, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Panushka","sequence":"additional","affiliation":[{"name":"Montefiore\/Albert Einstein College of Medicine, 1825 Eastchester Rd, Bronx, NY 10461, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,30]]},"reference":[{"key":"ref_1","first-page":"141","article-title":"Prevalence and trends of symptomatic pelvic floor disorders in U","volume":"123","author":"Wu","year":"2014","journal-title":"S. Women. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1007\/s11884-016-0344-9","article-title":"The burden of overactive bladder on U","volume":"11","author":"Reynolds","year":"2016","journal-title":"S. Public Health. Curr. Bladder Dysfunct. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1002\/nau.20476","article-title":"Is balance different in women with and without stress urinary incontinence?","volume":"27","author":"Smith","year":"2008","journal-title":"Neurourol. Urodyn."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1016\/j.urology.2005.05.047","article-title":"Urodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction","volume":"66","author":"Kuo","year":"2005","journal-title":"Urology"},{"key":"ref_5","first-page":"1263","article-title":"Urodynamic characteristics of women with stress urinary incontinence: Correlation with clinical findings","volume":"177","author":"Karram","year":"1997","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_6","first-page":"507","article-title":"Female urodynamics: Comparison of non-neurogenic voiding dysfunction patients with and without stress incontinence","volume":"55","author":"Lemack","year":"2000","journal-title":"Urology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1081","DOI":"10.1053\/apmr.2001.24297","article-title":"Contraction of the pelvic floor muscles during abdominal maneuvers","volume":"82","author":"Sapsford","year":"2001","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1002\/nau.20183","article-title":"Altered muscle activation patterns in symptomatic women during pelvic floor muscle contraction and Valsalva manoeuvre","volume":"25","author":"Thompson","year":"2006","journal-title":"Neurourol. Urodyn."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1007\/s00192-024-05729-z","article-title":"Assessment of involuntary pelvic floor muscle contractions in comparison with existing literature and IUGA\/ICS terminology reports","volume":"35","author":"Burkhard","year":"2024","journal-title":"Int. Urogynecol. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1097\/AOG.0000000000005536","article-title":"A treatment algorithm for high-tone pelvic floor dysfunction","volume":"143","author":"Torosis","year":"2024","journal-title":"Obstet. Gynecol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00192-016-3123-4","article-title":"An International Urogynecological Association\/International Continence Society joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction","volume":"28","author":"Bo","year":"2017","journal-title":"Int. Urogynecol. J."},{"key":"ref_12","first-page":"210","article-title":"Toileting behaviors, urinary cues, overactive bladder and urinary incontinence in older women","volume":"38","author":"Reynolds","year":"2019","journal-title":"Neurourol. Urodyn."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1089\/jwh.2024.0743","article-title":"Associations between U.S. women\u2019s toileting behaviors and lower urinary tract symptoms: A cross-sectional analysis of RISE for HEALTH study data","volume":"34","author":"Berry","year":"2025","journal-title":"J. Womens Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1002\/nau.23244","article-title":"Structured behavioral treatment research protocol for women with mixed urinary incontinence and overactive bladder symptoms","volume":"37","author":"Newman","year":"2018","journal-title":"Neurourol. Urodyn."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/nau.22751","article-title":"The standardization of terminology of lower urinary tract function in children and adolescents: Update report from the Standardization Committee of the International Children\u2019s Continence Society","volume":"35","author":"Austin","year":"2016","journal-title":"Neurourol. Urodyn."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1296","DOI":"10.1016\/j.juro.2009.12.059","article-title":"The management of dysfunctional voiding in children: A report from the Standardisation Committee of the International Children\u2019s Continence Society","volume":"183","author":"Chase","year":"2010","journal-title":"J. Urol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1472","DOI":"10.1002\/nau.24375","article-title":"Enduring impact of childhood adversity on lower urinary tract symptoms in adult women","volume":"39","author":"Epperson","year":"2020","journal-title":"Neurourol. Urodyn."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Van den Ende, M., Van de Steen, L., Everaert, K., Herv\u00e9, F., and Bou Kheir, G. (2025). Exploring childhood lower urinary tract symptoms, urinary tract infections and the microbiome: A systematic review. Life, 15.","DOI":"10.3390\/life15050730"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1016\/j.jpurol.2013.10.010","article-title":"Analysis of uroflow patterns in children with dysfunctional voiding","volume":"10","author":"Wenske","year":"2014","journal-title":"J. Pediatr. Urol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1007\/s001920070035","article-title":"Urodynamic assessment of voiding dysfunction and dysfunctional voiding in girls and women","volume":"11","author":"Everaert","year":"2000","journal-title":"Int. Urogynecol. J. Pelvic Floor. Dysfunct."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.1097\/01.AOG.0000190222.12436.38","article-title":"Effect of childhood dysfunctional voiding on urinary incontinence in adult women","volume":"107","author":"Minassian","year":"2006","journal-title":"Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1111\/iju.14740","article-title":"Which children are at risk of developing overactive bladder in early adulthood even if lower urinary tract symptoms improve during childhood?","volume":"29","author":"Selvi","year":"2022","journal-title":"Int. J. Urol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.ejogrb.2023.02.001","article-title":"Straining to void at preoperative urodynamic study as a risk factor for prolapse recurrence after surgery","volume":"283","author":"Mancarella","year":"2023","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.jpurol.2020.11.006","article-title":"Definitions, indications and practice of urotherapy in children and adolescents: A standardization document of the International Children\u2019s Continence Society","volume":"17","author":"Hussong","year":"2021","journal-title":"J. Pediatr. Urol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"628","DOI":"10.1016\/j.jped.2019.02.007","article-title":"Urotherapy in the treatment of children and adolescents with bladder and bowel dysfunction: A systematic review","volume":"95","author":"Assis","year":"2019","journal-title":"J. Pediatr. (Rio. J.)."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1097\/SPV.0000000000001470","article-title":"Reconstruction of urethral sphincter with polyacrylamide hydrogel","volume":"30","author":"Clearwater","year":"2024","journal-title":"Urogynecology"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1091","DOI":"10.1097\/JU.0000000000003435","article-title":"Updates to surgical treatment of female stress urinary incontinence: AUA\/SUFU guideline","volume":"209","author":"Kobashi","year":"2023","journal-title":"J. Urol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"829","DOI":"10.2147\/IJWH.S55383","article-title":"Prevention and management of postoperative urinary retention after urogynecologic surgery","volume":"6","author":"Geller","year":"2014","journal-title":"Int. J. Womens Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/SPV.0000000000001344","article-title":"Postoperative urinary retention","volume":"29","author":"McDermott","year":"2023","journal-title":"Urogynecology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1007\/s00192-016-2972-1","article-title":"Incidence of successful voiding and predictors of early voiding dysfunction after retropubic sling","volume":"27","author":"Barr","year":"2016","journal-title":"Int. Urogynecol. J."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Serati, M., Braga, A., Salvatore, S., Torella, M., Di Dedda, M.C., Scancarello, C., Cimmino, C., De Rosa, A., Frigerio, M., and Candiani, M. (2022). Up-to-date procedures in female stress urinary incontinence surgery: A concise review on bulking agents. Medicina, 58.","DOI":"10.3390\/medicina58060775"},{"key":"ref_32","first-page":"CD003881","article-title":"Urethral injection therapy for urinary incontinence in women","volume":"7","author":"Kirchin","year":"2017","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"S152","DOI":"10.5489\/cuaj.4612","article-title":"Periurethral bulking agents for female stress urinary incontinence in Canada","volume":"11","author":"Mamut","year":"2017","journal-title":"Can. Urol. Assoc. J."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"101223","DOI":"10.1016\/j.cont.2024.101223","article-title":"What do we really know about the external urethral sphincter?","volume":"10","author":"McCloskey","year":"2024","journal-title":"Continence"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1196\/annals.1389.034","article-title":"Functional anatomy of the female pelvic floor","volume":"1101","author":"DeLancey","year":"2007","journal-title":"Ann. N. Y. Acad Sci."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/hta24700","article-title":"Basic versus biofeedback-mediated intensive pelvic floor muscle training for women with urinary incontinence: The OPAL RCT","volume":"24","author":"Hagen","year":"2020","journal-title":"Health Technol. Assess."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1489","DOI":"10.1007\/s00404-023-06930-z","article-title":"The effect of pelvic floor muscle training in women with functional bladder outlet obstruction","volume":"307","author":"Lazaros","year":"2023","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/s00384-023-04513-7","article-title":"Electrical stimulation plus biofeedback improves urination function, pelvic floor function, and distress after reconstructive surgery: A randomized controlled trial","volume":"38","author":"Lv","year":"2023","journal-title":"Int. J. Color. Dis."},{"key":"ref_39","first-page":"CD012337","article-title":"Conservative interventions for treating urinary incontinence in women: An overview of Cochrane systematic reviews","volume":"9","author":"Hazelton","year":"2022","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1097\/SPV.0000000000001355","article-title":"Objective changes in pelvic floor muscle strength and length in women with high-tone pelvic floor dysfunction after pelvic floor physical therapy (RELAX trial)","volume":"29","author":"Volpe","year":"2023","journal-title":"Urogynecology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"284","DOI":"10.1097\/WNP.0000000000000187","article-title":"Laryngeal reflexes: Physiology, technique, and clinical use","volume":"32","author":"Ludlow","year":"2015","journal-title":"J. Clin. Neurophysiol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1016\/j.yebeh.2011.09.030","article-title":"Aura interruption: The Andrews\/Reiter behavioral intervention may reduce seizures and improve quality of life\u2014A pilot trial","volume":"22","author":"Elsas","year":"2011","journal-title":"Epilepsy Behav."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Schmid, F., Williams, J., Kessler, T., Stenzl, A., Aicher, W., Andersson, K.-E., and Eberli, D. (2021). Treatment of stress urinary incontinence with muscle stem cells and stem cell components: Chances, challenges and future prospects. Int. J. Mol. Sci., 22.","DOI":"10.3390\/ijms22083981"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1016\/j.juro.2016.05.136","article-title":"Regenerative medicine therapies for stress urinary incontinence","volume":"196","author":"Williams","year":"2016","journal-title":"J. Urol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7701\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T05:46:44Z","timestamp":1761889604000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/21\/7701"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,30]]},"references-count":44,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["jcm14217701"],"URL":"https:\/\/doi.org\/10.3390\/jcm14217701","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,30]]}}}