A importância da ultra-sonografia transvulvar na avaliação de parâmetros anatômicos relevantes no tratamento de mulheres com incontinência urinária de esforço

Abstract

OBJETIVO: Descrever a importância da ultra-sonografia transvulvar na avaliação das diferenças anatômicas induzidas pelas cirurgias de sling de fáscia lata e tension-free vaginal tape. MATERIAIS E MÉTODOS: Quarenta mulheres com incontinência urinária de esforço, com idades entre 30 e 60 anos, foram tratadas por sling de fáscia lata (20 pacientes) ou tension-free vaginal tape (20 pacientes). A ultra-sonografia transvulvar da junção uretrovesical e da uretra proximal foi a principal ferramenta de investigação pré- e pós-operatória. Os parâmetros estudados foram: distância vertical e distância horizontal da junção uretrovesical, distância pubouretral e comprimento da uretra proximal. RESULTADOS: A distância vertical da junção uretrovesical não variou significativamente após a sling de fáscia lata (p > 0,10). A distância pubouretral e a uretra proximal tornaram-se menores (p < 0,003) e a distância horizontal da junção uretrovesical tornou-se menor só no repouso (p = 0,03) após a sling de fáscia lata. A tension-free vaginal tape diminuiu o deslocamento vertical da junção uretrovesical (p = 0,0005) e o comprimento da uretra proximal (p = 0,02). CONCLUSÃO: A ultra-sonografia transvulvar foi fundamental para documentar que as cirurgias de sling de fáscia lata e tension-free vaginal tape alongam a uretra proximal, sendo a sling de fáscia lata de forma mais eficaz. A sling de fáscia lata enfoca a diminuição da distância pubouretral e a tension-free vaginal tape, o deslocamento vertical da junção uretrovesical.

Effects of Pelvic Floor Muscle Training with Biofeedback in Women with Stress Urinary Incontinence

“…However, regardless the cause of SUI, nowadays, there is some consensus also to measure urethral hypermobility 30 . Recently, ultrasound seems to play an important role in the study of the urethral vesical junction(UVJ) and the proximal urethra (PU), also because it is a simple, low-cost, innocent and easily repeatable technique 30,31,32 .…”

Ultrassonografia uretrovesical como método eficaz de avaliação dos parâmetros prognósticos de tratamento cirúrgico da incontinência urinária de esforço

“…However, the urodynamic study can only indirectly demonstrate the vertical mobility of the urethrovesical junction (UVJ) and proximal urethra (PU). Differently, ultrasonography can demonstrate a real image, with positioning and mobility of the UVJ and PU (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) .…”

“…Ultrasonography of the UVJ and PU has increasingly been used in the preoperative evaluation of patients with stress urinary incontinence as well as in their postoperative follow-up for defining topographic parameters regarding the UVJ and PU positioning according to the surgical technique utilized (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(17)(18)(19) . An original study demonstrates that the UVJ and PU positioning represents a good prognostic factor of the success or failure of the surgical correction of stress urinary incontinence (14) .…”

Transvulvar ultrasound of urethrovesical junction and proximal urethra as prognostic markers of burch procedure outcome

“…The importance of the urethrovesical junction (UVJ) and proximal urethra (PU) mobility in the maintenance of female urinary continence has already been established [4,[6][7][8][9][10][11] . However, the urodynamic evaluation determines only indirectly the UVJ and PU mobility, differently from what can be clearly demonstrated in real time imaging by ultrasound [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20] .…”

“…The ultrasonographic examination of the UVJ and PU has been increasingly used in the preoperative evaluation and postoperative follow-up of patients with SUI, to document the UVJ and PU positioning before and after the elected surgical treatment [4][5][6][7][8][9][10][11][12][13][17][18][19] . At least one study suggested that the positioning of the UVJ and PU in the postoperative period is a good marker for treatment prognosis (whether a surgical procedure for SUI correction had been successful or not) [14] .…”