Introital ultrasonography: a comparison of women with stress incontinence due to urethral hypermobility and continent women

Abstract

at rest and on straining. Several distances were measured to determine if any provided an objective distinction between continent and incontinent women. RESULTSAmong all the IUS variables assessed, sliding (calculated as the difference between the distance urethra-bladder neck, U-BN, at rest and under stress) was the best for distinguishing continent and incontinent women. The receiver operating characteristic curves showed that with a threshold of 8 mm, sliding had a sensitivity of 92% and a specificity of 79.6% for detecting SUI due to UH. The distances symphysis-urethra (S-U) and U-BN at rest could also discriminate, but with lower significance. CONCLUSIONSIUS is an important tool for diagnosing SUI; there are three independent variables, one dynamic (sliding) and two static (distances S-U and U-BN), that can be used to distinguish between continent women and those with SUI due to UH. Sliding is the most reliable, as it has the highest sensitivity and specificity. We think that the simplicity, low financial cost and reliability of IUS could allow it to be a routine procedure for physicians working in incontinence units. KEYWORDSstress urinary incontinence, sliding, urethral hypermobility, introital ultrasonography OBJECTIVETo determine if there is a variable on introital ultrasonography (IUS) that can be used to distinguish between women with stress urinary incontinence (SUI) due to urethral hypermobility (UH) and continent women. PATIENTS AND METHODSThis single-centre, prospective, blind, cohort, observational study comprised 383 women (245 continent and 138 incontinent) who were all appropriately informed volunteers selected according to the inclusion criteria. IUS with a convex probe was performed on all women; the measurement plane was standardized and coordinates were obtained

Pelvic floor muscle training in women with stress urinary incontinence causes hypertrophy of the urethral sphincters and reduces bladder neck mobility during coughing

“…This result was as expected. The action of the PFMs has been shown to hold the urethra in place such that it can be compressed between that anterior vaginal wall and the PS during tasks that increase intra‐abdominal pressure . As such, a reduction of bladder neck excursion during coughing is an expected outcome.…”

“…pressure. 4,[14][15][16] As such, a reduction of bladder neck excursion during coughing is an expected outcome. Conversely, a properly performed Valsalva maneuver involves complete relaxation of the PFMs, 28,30 and therefore challenges the passive resistance of the PFMs and endopelvic fascia.…”

“The cough game”: are there characteristic urethrovesical movement patterns associated with stress incontinence?

“…For example, several studies have used women with symptoms of lower urinary tract dysfunction in the absence of stress incontinence during evaluation as controls [14]. Another study utilized a control group with significant differences from the study group in both age and parity [15]. Having controls that are younger than cases with SUI could bias the results and may be partly responsible for earlier studies revealing greater differences between groups.…”

The Link Between Female Obesity and Urinary Stress Incontinence

“…As regards the use of ultrasound in evaluation of bladder neck mobility, some authors found a lower mean bladder neck descent in continent women than in incontinent women during straining [36,37].…”