No abstract

Objective To assess urethral vascularization in healthy young women, using colour Doppler ultrasonography. Subjects and methods Eleven healthy young women volunteers (mean age 33.6 years, range 24±46) with no pelvic¯oor disorders and no history of incontinence were assessed. The subjects underwent colour Doppler ultrasonography using a 4±7 MHz convex broadband transducer. Translabial sagittal scans of the urethra were taken when the subjects had a full bladder, both during the oestrogenic and progestogenic phases. The colour Doppler ultrasonography parameters were optimized to detect slow¯ows in the anterior and posterior distal, middle and proximal urethra. A rank-sum nonparametric test was used to assess differences between the resistive indices. Results The statistical evaluation showed a signi®cant difference in the resistive index only in the anterior urethra, between the distal and middle plus proximal urethra, in both the progestogenic (P=0.002) and oestrogenic (P=0.0127) phases. Conclusions This study con®rmed that the vascularization of the urethra plays an important role in the`seal' effect, which is considered one of the most important factors in urethral closure. There was a signi®cantly greater resistive index in the anterior proximal urethra than in the middle and distal urethra. These ®ndings suggest that the seal effect is related to the existence of a rich venous urethral vascularization, involved in the mechanism of urethral closure. Colour Doppler ultrasonography of the urethra seems to be feasible and useful for understanding the mechanism of the vascular component in female continence.

Study design: Prospective study. Objectives: To evaluate the feasibility of color ultrasound imaging of the urethra in association with UPP to diagnose intrinsic sphincter de®ciency (ISD). Setting: Italy. Methods: We studied a group of 13 normal female volunteers (mean age 29 years) during the estrogenic phase and a group of 15 patients (mean age 63.9 years) with ISD. All patients and normal volunteers underwent color ultrasound imaging using a 4 ± 7 MHz convex broad band transducer. Translabial sagittal scans of the urethra were obtained. The color ultrasound parameters were optimized for detection of parenchymal slow¯ows. A subjective score of the degree of vascularization along the entire urethra was established as follows: (a) minimal or absent (1), (b) poor (2), (c) moderate (3), (d) good (4). Statistical analysis, using the nonparametric Mann-Whitney rank sum test, was carried out to determine di erences of ultrasound scores between volunteers and patients. Results: The statistical evaluation showed that the di erences between the ultrasound scores in the two groups was statistically signi®cant (P50.001). Conclusion: We a rm that color ultrasound imaging of the urethra seems to be feasible and useful in association with UPP in the diagnosis of ISD even if this echographic investigation needs further observations.

Objectives: To assess the urodynamic and clinical outcome of a laparoscopic autoaugmentated bladder. Methods: Laparoscopic bladder autoaugmentation in a 27-year-old woman with an incomplete spinal cord injury at T12 level with urge incontinence caused by a hyperre¯exic bladder. Results: Six months later the patient voids by Valsalva's manoeuvre every 3 h and remains dry day and night. The radio-urodynamic study, performed 2 months later, revealed an intact bladder with a diverticulum of anterior wall and a capacity of 510 ml with ®lling rate of 100 ml/min without evidence of leakage of infusion water. Conclusion: Laparoscopic retropubic auto-augmentation allows a brief hospital stay and minor postoperative discomfort. Moreover the laparoscopic approach should not complicate or preclude subsequent enterocystoplasty if necessary. Spinal Cord (2000) 38, 59 ± 61