Perineal Ultrasound Evaluation of Dysfunctional Voiding in Women With Recurrent Urinary Tract Infections

Abstract

We think that perineal ultrasound is useful in the evaluation of dysfunctional voiding in women with recurrent urinary tract infections.

Urinary Tract Infections and Dysfunctional Voiding

“…Urethral sphincter volume was measured using a 7.5 MHz transvaginal ultrasound probe, where volume was calculated using formula for the volume of a cylinder, as described (Kondo et al, 2001;Wiseman et al, 2002). We observed that maximum urethral sphincter volume was significantly increased in patients with recurrent UTIs and dysfunctional voiding (2.87+0.41 cm 3 ) compared to patients with recurrent UTIs and normal perineal activity during voiding and to control patients (1.77+0.62 cm3 and 1.61+0.32 cm 3 respectively); abnormal findings at ultrasound included thickening of individual rings, haziness of contours and change in echogenic texture with loss of the characteristic four-rings appearance; these findings were observed only in patients with dysfunctional voiding (Minardi et al, 2008). Detrusor wall thickness as assessed by suprapubic ultrasound ranged from 2.2 to 9.3 mm.…”

“…Sudden variations in the urethral pressure during bladder filling in people affected by DV were demonstrated, represented by pressure decreases with short periods of electromyography silence, intermittent urethral pressure increases with short perineal spasms, or urethral pressure decreases with silent electromyography, combined with different degrees of bladder instability (Vereecken & Proesmans, 2000). Furthermore, some degree of external sphincter hypertrophia was noted in some studies conducted on females affected from dysfunctional voiding and a positive correlation between dysfunctional behaviors and sphincter volume postulated (Minardi et al, 2008). Its role in the pathogenesis is, anyway, still to be determined.…”

“…Some findings are typical of DV at the urodynamic evaluation. In these cases the contextual registration of needle EMG is very helpful (Minardi et al, 2008).…”

“…In studies conducted on women with stress-urinary incontinence three-dimensional ultrasound has been shown to be a reproducible method of assessing urethral sphincter volume, where it has been shown to correlate with the area under the urethral pressure profile curve, suggesting a relationship between structural and functional anatomy (ToozsHobson et al, 2001;Athanasiou et al, 1999;Robinson et al, 2004). Perineal ultrasound was used by our group to assess function and morphology of the urethral sphincter and of the detrusor muscle in the evaluation of dysfunctional voiding in female patients with recurrent urinary tract infections (UTIs) (Minardi et al, 2008). The study population comprised women referred to our Department with more than a 3-year period of recurrent UTIs, and dysfunctional voiding.…”

“…respectively). The ROC analysis showed that, to identify a patient with dysfunctional voiding, a sphincter volume threshold of 1.94 mm 3 has 100% sensitivity and 63.2% specificity; a detrusor thickness threshold of 4.95 mm has 100% sensitivity and 85.4% specificity; at these cut-off values, 56.9% of patients with dysfunctional voiding had both the two ultrasound parameters above the threshold level (Minardi et al, 2008). In our study by the analysis of opening/maximum flow detrusor pressure and mean/maximum urethral closure pressure, patients with recurrent UTIs associated with dysfunctional voiding are obstructed; similarly, by the analysis of detrusor thickness and striated sphincter volume at ultrasound, we can diagnose obstruction.…”