Application of Transrectal Ultrasonography in Modified Stamey Procedure for Stress Urinary Incontinence

Abstract

From June 1989 to August 1990, 21 women with genuine stress urinary incontinence were treated with the Gittes procedure combined with transrectal ultrasonography. The urethrovesical junction was well pinpointed on an ultrasonographic image. The strength of suspension providing the optimal posterior urethrovesical angle was changed by each patient. Posterior urethrovesical angles averaged 89.3 +/- 9.5 degrees at operation and 93.6 +/- 9.5 degrees (mean +/- standard deviation) on a postoperative lateral cystourethrogram with the patient straining while in the standing position. An indwelling urethral catheter was removed on postoperative day 1. None of the patients had residual urine of more than 50 ml. by 4 days postoperatively. Furthermore, the average maximum urinary flow rates significantly increased from 21.0 +/- 7.1 ml. per second preoperatively to 26.1 +/- 9.8 ml. per second postoperatively (p less than 0.01). Therefore, application of ultrasonography during bladder neck suspension is simple and reliable for determination of the optimal suspension as well as identification of the suspension site.

Ultrasonography in stress urinary incontinence

“…All the authors [32][33][34][35] who perform introital ultrasonography used the PUVA as a criterion. It was also used by the authors who performed perineal ultrasonography [23] and transrectal ultrasonography [51,53], but not in transvaginal ultrasonography. Some authors state that the PUVA is not discriminate for SUI [30,38,40,52].…”

“…Yamada et al [53] performed transrectal ultrasonography before the Stamey operation and during the operation on the cases with SUI. They set the PUVA at 80-100 ~ and fastened the suture materials.…”

“…During ultrasonographic examination the bladder is filled with fluid to least 200 ml [37,40], 200-300 ml [51,54], 400 ml [39], 250 ml [24,53], 300 ml [23,27,28,30,34], 100-400 [251 or fully [10,21,38,39,41,[47][48][49][50]. In one study [45] the bladder was filled with 250 ml and 500 ml fluid and vaginal ultrasonography was repeated.…”

A new ultrasonographic method for evaluation of the results of anti‐incontinence operations

“…However, some of these procedures can not achieve this goal mainly due to inappropriate methods or technical failures. Ultrasonography has been used for postoperative evaluation of patients to document the reasons of failed operations (4–7). These evaluations suggested that patients with successful operations had beneficial stabilization of the bladder necks by surgical repair, while those with persistent or recurrent incontinence were associated with reacquisition of the bladder neck hypermobility (4–9).…”

“…Ultrasonography has been used for postoperative evaluation of patients to document the reasons of failed operations (4–7). These evaluations suggested that patients with successful operations had beneficial stabilization of the bladder necks by surgical repair, while those with persistent or recurrent incontinence were associated with reacquisition of the bladder neck hypermobility (4–9). Although, several different measurement methods have been proposed to objectively document the position or the mobility of the bladder neck, the effectiveness of these methods was controversial (4–13).…”