Ultrasonography as a screening tool for paravaginal defects in women with stress incontinence: A pilot study

Abstract

The aim of the study was to determine whether transabdominal ultrasonography can accurately identify paravaginal defects associated with genuine stress urinary incontinence. Sixteen women were diagnosed with genuine stress urinary incontinence (GSUI) following clinical evaluation, urethroscopy and urodynamic studies. They were then evaluated by transabdominal sonography and a full bladder and immediately following micturition. The ultrasound studies were also carried out in 8 women (5 nulliparous and 3 primiparous) who had no signs or symptoms of urinary incontinence. Paravaginal defects were detected in the 16 women with GSUI: 9 had unilateral defects and 7 had bilateral defects. Only right-sided defects were identified in women with unilateral lesions. Paravaginal defects were confirmed in all symptomatic women at the time of surgery, and corresponded with the defects identified with transabdominal ultrasound. Mild unilateral paravaginal defects were identified in 2 continent parous women. Five nulliparous women and 1 primiparous control had no ultrasound evidence of paravaginal defects. A transabdominal, transverse, suprapubic ultrasound scan with a full bladder is a promising screening technique for the diagnosis of paravaginal defect in women with GSUI. Transabdominal suprapubic longitudinal sections are not useful for the identification of paravaginal defects.

Ultrasound imaging of paravaginal defects in women with stress incontinence before and after paravaginal defect repair

“…Hypermobility of the bladder neck and cystourethrocele can be associated with PVDs. Sonographic scanning of a PVD was first described by Ostrzensky and Osborne 13 . The aim of surgical repair is to restore normal anatomy.…”

Paravaginal defect: anatomy, clinical findings, and imaging

“…In 1997 and 1998, Ostrzenski [10,11] published the first papers on US and paravaginal defects. In these studies, the assumption was that the shape of the bladder and vagina would reflect structural defects in the anterior wall supports.…”

Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging

“…In order to make detection of paravaginal defects more objective, some authors have used transabdominal ultrasound, with conflicting results. [5][6][7][8] Paravaginal defects are supposed to be present when an asymmetry of the caudal contour of the bladder is observed in an oblique coronal view. However, as both uterine position and size as well as rectal filling can influence results and as it is impossible to standardise the assessment plane due to an absence of landmarks in the coronal plane, it is not surprising that the method has been found unreliable.…”