Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse

Abstract

PurposeThe study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP).Materials and MethodsA total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II.ResultsPoint Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters α-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R→V and angle of rotation (ρ), which were significantly higher in the USI group than in the USIGP group during VM.ConclusionsAccording to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.

Transperineal ultrasonography in stress urinary incontinence: The significance of urethral rotation angles

“…The resting α angle values in these studies are higher than those obtained in our present study, taking into consideration that all these studies used different routes of US examination (transvaginal and introital US), the distortion of the anatomy of the urethra caused by the pressure of the closely applied transducer, in addition to the fact that the transvaginal and introital US transducers are less supported than the transducer applied to the perineum allowing more mobility of the probe during the examination, thus adding more to the distortion of the anatomy, which may be responsible for the higher numerical values of the α angle. On the other hand, Antovska [11] in a study conducted on 132 patients with SUI, reported mean (SD) α angle values of 67.2 (4.5) and 66.9 (3.3) ° at rest and stress, respectively, with no statistical significance between them. Once again, the variation in the methodology of the US examination could be a major but not sole factor, as in the aforementioned study the author preferred to empty the urinary bladder of the patients completely by catheterisation immediately before the TPUS.…”

“…The US assessment of the dynamic bladder neck position, the angle of inclination (α angle) and posterior urethrovesical angle (β angle) in normal subjects and in patients with UI has been investigated by several researchers [4] , [5] , [10] , [11] , [12] , [13] , [14] , [15] . Although, all these studies agree in some way or another that urethral angles are different between the normal individual and patients with UI, and that they undergo dynamic changes upon straining (Valsalva manoeuvre), the numerical values obtained are variable and no clear definition of ‘normal’ or ‘abnormal’ values has been set.…”

The role of transperineal ultrasound in the evaluation of stress urinary incontinence cases

“…Transperineal ultrasonography has also been introduced to evaluate the mobility of the bladder neck and proximal urethra. The majority of the prior studies concentrated on the degree of urethral angle (α), posterior urethrovesical angle (β), and bladder neck descent (BND), but there is a limited number of studies about rotation angles (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14). Moreover, to the best of our knowledge, there are no studies comparing the Q-tip test with transperineal ultrasonography and investigating Visual Analogue Scale (VAS) scores.…”

Correlation between trans-perineal ultra-sonography, urodynamic study and physical examination findings in female patients with stress urinary incontinence: Single center experience

“…It is probable that proximate placing the US transducer will produce a compression effect on urethra and may distort the urethral anatomy which may result in different numerical reports of α angle. On the other hand, Antovska 12 studied 132 patients with SUI, and found there is no statistical significance difference between the mean (SD) α angle values at rest and straining, respectively [67.2 (4.5) and 66.9 (3.3)°]. In the aforementioned study, the author preferred to empty the urinary bladder of the patients completely by catheterization immediately before the TPUS.…”

“…10 The ultra-sonographic assessment of the bladder neck position, α angle and β angle in both continent and incontinent female patients has been focused on by several researchers. 4,5,[10][11][12][13][14][15] Although, a unique definition of "normal" or "abnormal" values are not established yet. These variations can be attributed to the different methodology of the US examination (perineal, transvaginal, or interoital), the radiologist experience, the protocol of urinary bladder filling, and also different quality of performing the Valsalva maneuver by each patient.…”