Size Does Not Make the Difference: 3D/4D Transperineal Sonographic Measurements of the Female Urethra in the Assessment of Urinary Incontinence Subtypes

Kupec, Tomáš; Pecks, Ulrich; Graf, C; Stickeler, Elmar; Meinhold‐Heerlein, Ivo; Najjari, Laila

doi:10.1155/2016/1810352

Cited by 10 publications

(5 citation statements)

References 24 publications

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“…Najjari et al demonstrated longer urethras in incontinent patients performing perineal sonography 36 . Kupec et al found greater urethral length and wider urethral lumen in SUI patients compared with healthy controls 37 . Obviously, other factors than pure anatomical length contributed to physiological urethral function.…”

Section: Discussionmentioning

confidence: 97%

“…Despite other groups reported longer urethras to be correlated with better continence 16,17,23 , our study data do not support this findings. There are a few studies available reporting longer urethras rather being associated with incontinence 36,37 . Najjari et al demonstrated longer urethras in incontinent patients performing perineal sonography 36 .…”

Section: Discussionmentioning

confidence: 99%

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Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Mothes

Kather

et al. 2021

Sci Rep

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Urethral length was evaluated retrospectively in patients with prolapse undergoing anterior native-tissue repair. Effects of age, prolapse stage, defect pattern, urodynamic and clinical stress test findings, and tension-free vaginal tape (TVT) surgery indication were analyzed using Mann–Whitney and Wilcoxon tests and linear and logistic regression. Of 394 patients, 61% had stage II/III and 39% had stage IV prolapse; 90% of defects were central (10% were lateral). Median pre- and postoperative urethral lengths were 14 and 22 mm (p < 0.01). Preoperative urethral length was greater with lateral defects [p < 0.01, B 6.38, 95% confidence interval (CI) 4.67–8.08] and increased stress incontinence risk (p < 0.01, odds ratio 1.07, 95% CI 1.03–1.12). Postoperative urethral length depended on prolapse stage (p < 0.01, B 1.61, 95% CI 0.85–2.38) and defect type (p = 0.02, B – 1.42, 95% CI – 2.65 to – 0.2). Postoperatively, TVT surgery was indicated in 5.1% of patients (median 9 months), who had longer urethras than those without this indication (p = 0.043). Native-tissue prolapse repair including Kelly plication increased urethral length, reflecting re-urethralization, particularly with central defects. The functional impact of urethral length in the context of connective tissue aging should be examined further.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Mothes

Kather

et al. 2021

Sci Rep

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“…Urodynamics analyses the functional anatomy of the bladder, urethra, or both, and their reaction to filling, storing, and voiding, regardless of the method used (7). Urodynamic testing is essential in urogynecology because it provides objective descriptions of incontinence and voiding dysfunction (8). Therefore, the objectives of this study were to analyze the urodynamic changes before and after laparoscopic and vaginal hysterectomy.…”

Section: Original Papermentioning

confidence: 99%

Urodynamic changes following laparoscopic versus vaginal hysterectomy

Abouelgreed

Saleh

Abdelaal

et al. 2022

Arch Ital Urol Androl

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Objective: To compare urodynamic changes before and after hysterectomy (laparoscopic vs. vaginal approach) for benign gynecological diseases.Patients and methods: A total of 90 women with a mean age of 56.36-years were enrolled in this study between August 2019 and April 2021. They were divided into two equal groups(45 patients each). Group, I had a vaginal hysterectomy, and Group II had a laparoscopic hysterectomy. All patients were assessed clinically using ICIQ-FLUTS questionnaire and a uro-dynamic study before and six months after surgery. Results: Both vaginal and laparoscopic hysterectomy did not signiﬁcantly change the maximum ﬂow rate, voiding time, and average ﬂow rate. The increase in residual urine volume in group I was not signiﬁcant (p = 0.129), as was in Group II(p = 0.217). All the modiﬁcations, however, were within permis-sible limits. According to the cystometry result, volume at initial sensation rose in both groups after surgery, with no statistically signiﬁcant difference (p = 0.364). After both forms of hysterecto-my, maximum bladder capacity did not vary considerably. Preoperatively, all study participants exhibited no overactivity of the detrusor muscle; nevertheless, following surgery, overac-tivity was noted in 9 patients after vaginal hysterectomy com-pared to three patients after laparoscopic hysterectomy, and all the alterations were within a clinically acceptable range. In addition, the ICIQ-FLUTS score was not signiﬁcantly different between the study groups. Conclusions: According to the urodynamic study, hysterectomy for benign uterine conditions, whether vaginal or laparoscopic did not adversely affect urinary bladder function.

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“…Four-dimensional (4D) pelvic floor ultrasound is a safe and noninvasive tool, which has been widely used as a tool to virtually reconstruct the anatomical structure of the female urethra in SUI (12)(13)(14). In previous literature, measuring the ultrasonic parameters of the tape at a single point or multiple positions has been used to explore the mechanism of TOT procedures, including morphological information changes and the anatomical morphology, function, and behavior of the surgical site (13-18).…”

Section: Introductionmentioning

confidence: 99%

Significance of 4D US parameters for the clinical treatment of female patients with stress urinary incontinence

et al. 2023

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BackgroundStress urinary incontinence (SUI) that has been associated with abnormal pelvic floor muscle function or morphology is a common condition. This research aimed to study the impact of the four-dimensional (4D) pelvic floor ultrasound on the treatment of female patients with clinical diagnosis of SUI and to evaluate its clinical significance on SUI.MethodsWe enrolled 51 women with SUI. Before transobturator suburethral tape procedures, the patients underwent 4D pelvic floor ultrasonography. The measurements include residual urine volume, bladder detrusor thickness in resting state, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis at rest and Valsalva movement, posterior angle of bladder urethra, and urethral rotation angle. The degree of movement of the bladder neck (the difference between the vertical distance from the bladder neck to the posterior inferior edge of the pubic symphysis under the resting state and the maximum Valsalva movement) and the formation of a funnel at the internal orifice of the urethra were calculated.ResultsThe mean bladder detrusor thickness was 2.6 ± 0.9 mm, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis was 27.7 ± 4.5 mm, the posterior angle of the bladder was 122.7 ± 18.9°, the vertical distance from the rectal ampulla to the posterior inferior edge of pubic symphysis was 18.5 ± 4.6 mm, and the mean area of hiatus of the levator ani muscle was 22.1 ± 6.0 cm2. The mean posterior angle of the bladder on Valsalva was 159.3 ± 23.1°, and the mean urethral rotation angle was 67.2 ± 21.4°.ConclusionsThe 4D pelvic floor ultrasound is a reliable method in evaluating preoperational morphological characteristics of patients with SUI. With the help of the 4D pelvic floor ultrasound, the individualized treatment regimen can be developed and, more importantly, the inappropriate surgical decision can be avoided.

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Size Does Not Make the Difference: 3D/4D Transperineal Sonographic Measurements of the Female Urethra in the Assessment of Urinary Incontinence Subtypes

Cited by 10 publications

References 24 publications

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Inverse correlation between urethral length and continence before and after native tissue pelvic floor reconstruction

Urodynamic changes following laparoscopic versus vaginal hysterectomy

Significance of 4D US parameters for the clinical treatment of female patients with stress urinary incontinence

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