Urethral support in female urinary continence part 1: dynamic measurements of urethral shape and motion

Routzong, Megan R.; Chang, Cecilia; Goldberg, Roger P.; Abramowitch, Steven D.; Rostaminia, Ghazaleh

doi:10.1007/s00192-021-04765-3

Cited by 8 publications

(12 citation statements)

References 25 publications

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“…15 This helps to validate the results of the previous study and further supports that more urethral mobility that consists of the urethra swinging around the pubic bone toward the outside of the body is associated with SUI. 12,15,21 Squeeze, which represented active urethral closure, exhibited very different mechanisms compared with strain. As shown by the 2-D measurements and the FIGURE 3.…”

Section: Discussionsupporting

confidence: 84%

“…Asymptomatic values are from this study, whereas the other 3 groups are from our laboratories' previous work on symptomatic urethral shape. 15 The no SUI group was characterized by patients who reported to a urodynamic center for evaluation but were not diagnosed with SUI. Increasing values for urethral knee-pubic bone angle and retropubic bladder neck angle meant increased urethral motion inferiorly out of the body, whereas decreasing values of bladder neck-pubic bone angle meant increased motion.…”

Section: Discussionmentioning

confidence: 99%

“…Anatomical measures were then taken on the midsagittal images consistent with our previous study. 15 These measures included the following: (1) urethral length, defined as the distance between the proximal opening of the urethra (at the intersection with the bladder) and the urethral meatus following the urethral lumen; (2) retropubic urethral length, defined as the distance between the proximal end of the urethra and the line perpendicular to the urethra at rest and passes through the inferior-posterior point of the pubic symphysis; (3) retropubic bladder neck angle, defined as the included angle between the line connecting the bladder neck to the inferior-posterior pubic symphysis point and the line along the superior edge of the pubic symphysis from that point (Fig. 1A); (4) bladder neck-pubic bone angle, defined as the included angle between the line connecting the bladder neck and the line perpendicular to the urethra that passes through the inferior-posterior point of the pubic symphysis; and (5) urethral knee-pubic bone angle, defined as the included angle between the lines connecting the urethral knee to the inferior-posterior pubic symphysis and the line perpendicular to the urethra used in the retropubic measurements (Fig.…”

Section: Ultrasound Measurementsmentioning

confidence: 99%

“…1B). 15 After each of the urethral traces were rigidly aligned using a custom iterative closest point analysis in Python, corresponding points were established between each of the participant-specific shapes. To accomplish this, a template shape was drawn manually to resemble the general shape of the urethral traces.…”

Section: Statistical Shape Modelmentioning

confidence: 99%

“…15 This study used pelvic floor ultrasound to visualize the mobility of the urethra during various maneuvers (squeeze and strain) and significant differences in shape of the urethra between maneuvers and between severity of SUI (no vs mild vs severe SUI). 15 However, the patients in the "no SUI" group of our previous study had other pelvic floor disorder symptoms, including prolapse. Thus, it is difficult to define anatomical differences that may be used for diagnostic purposes between asymptomatic and symptomatic patients for SUI.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Effect of Squeeze, Cough, and Strain on Dynamic Urethral Function in Nulligravid Asymptomatic Women: A Cross-Sectional Cohort Study

Martin

Routzong

Abramowitch

et al. 2023

UROGC

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Importance In the past, urethral shape, mobility, and urodynamics have been used to retrospectively demonstrate correlations with stress urinary incontinence. Our previous work has shown a relationship between urethral function and shape in symptomatic women. Objective This study aimed to characterize the effect of pelvic floor squeeze and strain maneuvers on urethral shapes and pressure in a cohort of patients without pelvic floor disorders. Study Design In this cross-sectional study, volunteers underwent dynamic pelvic floor ultrasound examination, and a modified urodynamic study. Urethral length, thickness, and proximal and distal swing angles were measured at rest, squeeze, and strain. The midsagittal urethral walls were traced so that a statistical shape model could be performed. Means and standard deviations of imaging and urodynamic measures were calculated. Results Data from 19 participants were analyzed. On average during squeeze compared with rest, urethral length increased by 6%, thickness decreased by 42% (distal, P < 0.001), 10% (middle), and urethral pressure increased by 14%. Opposite shape changes—length decreased by 10% (P = 0.001), thickness increased by 57% (distal, P < 0.001), 20% (middle, P < 0.001)—and increased urethral mobility were observed during strain, with larger pressure increases occurring (29%, P < 0.001). Fifty-one percent of the total shape variance described the differences between maneuvers. These differences were statistically different between groups (P < 0.001 for comparisons, all others P > 0.05). Conclusions Dynamic ultrasound and urodynamics allow for the establishment of baseline ranges in urethral metrics (2-dimensional measures, shape, and pressure) and how they are altered during maneuvers. These data can allow for a more objective identification of incontinence via ultrasound and urodynamic testing.

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