<b>The Urethra and Its Supporting Structures in Women with Stress Urinary  Incontinence:</b> MR Imaging Using an Endovaginal Coil

Kim, Jeong Kon; Kim, Yong Jae; Choo, Myoung Soo; Cho, Kyoung-Sik

doi:10.2214/ajr.180.4.1801037

Cited by 81 publications

(45 citation statements)

References 22 publications

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“…Others have shown that urethral sphincter area and circumference decrease as the severity of stress incontinence increases [26]. Another MRI study found that the urethral sphincter is thinner in incontinent women than in asymptomatic women [27].…”

Section: Discussionmentioning

confidence: 96%

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

et al. 2006

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This study correlated Doppler resistive indices (RIs) with maximum urethral closure pressures (MUCPs) in women with stress urinary incontinence. We hypothesized that urethral blood flow would be inversely correlated to urethral closure pressures. Fifty-three women underwent spectral Doppler waveform analyses of periurethral vasculature to calculate RI. Urethral morphology including pubovesicular length (PVL) with and without cough was measured. MUCPs were obtained according to International Continence Society guidelines. Physical exam and history were also obtained. Correlation coefficients were calculated for comparisons of Doppler measurements and closure pressures. Fifty patients were required to detect a difference between no correlation and a modest correlation of 0.38 with 80% power and alpha of 0.05. Significance is set at p<0.05. Measurements were reproducible between Doppler waveforms and MUCP measurements (all p=NS). RI was not correlated with age, parity, MUCP, Incontinence Impact Questionnaire-7 scores, urethral length, or urethral width (all p=NS). RI and MUCP were likewise not associated with history of diabetes, hypertension, or anterior vaginal prolapse to or beyond the hymen (all p=NS). MUCP was negatively correlated with age (r=-0.33, p=0.01) even when controlled for hormonal status (ANCOVA, p=0.003) and positively correlated with urethral/bladder neck diameter (r=27, p=0.05), PVL (r=0.30, p=0.03), and PVL with cough (r=0.36, p=0.009).

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Section: Discussionmentioning

confidence: 96%

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

et al. 2006

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“…Overfat women have high values of intra-abdominal pressure [3] which may increase the intra-vesical pressure and urethral mobility, and affect pelvic floor muscles [3,32,33,35]. Another anatomical explanation would be the association between retropubic space and stress UI since overweight women have more retropubic space than their normal-weight counterparts [36]. Limited individual mobility and sedentarism may influence severity and type of UI [37].…”

Section: Discussionmentioning

confidence: 99%

Associations between obesity, physical fitness, and urinary incontinence in non-institutionalized postmenopausal women: The elderly EXERNET multi-center study

et al. 2015

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“…Other pathological causes have been attributed to urethral hypermobility, intrinsic sphincter deficiency, or urethral trauma (e.g., resulting from childbearing, surgical trauma, prolonged increased abdominal pressure) [21][22][23]. Women suffering from SUI often fear urinary leakage and are therefore impaired in their social or physical activities [24].…”

Section: Anterior Compartmentmentioning

confidence: 99%

MRI of the Pelvic Floor and MR Defecography

Maccioni

Alt

2018

IDKD Springer Series

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The female pelvic floor is a complex functional and anatomic system. It is composed of an active muscular component and a passive support system. Furthermore, it is topographically divided in three main functional and anatomic compartments: the anterior, supporting the bladder and urethra; the middle, supporting the vagina and uterus; and the posterior or anorectal compartment [1]. When the pelvic floor is damaged in its fascial, muscular, or neural components at the level of any of its three compartments, several pelvic floor dysfunctions or disorders (PFD) may arise [2]. As pelvic floor muscles and fasciae act like a unique functional entity, dysfunction of one compartment is commonly associated with various dysfunctions of the other compartments as well. Hence, a multidisciplinary team, often called a pelvic floor unit, is strongly recommended that includes urogynecologists, urologists, gastroenterologists, proctologists, physicians, radiologists, physiotherapists, and specialized nurses. Additionally, the correct diagnosis of the specific PFD and the identification of all associated disorders are mandatory for an effective conservative or surgical treatment. Dynamic MRI provides excellent morphological and functional display of the pelvic floor and is therefore additionally applied for a comprehensive overview of the pelvic floor and the entire pelvic structures. Evaluation is best done by performing a standardized MRI procedure and using a systemic approach to report the MRI findings [3]. To improve effective communication between the radiologist and the clinician, it is also relevant to understand the specific lesions underlying PFD and to explain the frequent association of disorders in different pelvic compartments. Functional Anatomy of the Pelvic Floor PathogenesisThe pelvic floor is an integrated system composed of an active component, the striated muscles, and a passive support system, the suspensory ligaments and fascial coverings, and is associated with an intricate neural network. It not only provides support for the pelvic viscera (bladder, bowel, uterus) but maintains their functioning, thanks to the combined action of the two major pelvic floor structures: the levator ani muscle (LAM), and the endopelvic fascia [1, 2, 4]. Levator Ani Muscle (LAM)The LAM has two main components: the iliococcygeus and pubococcygeus muscles. Various muscle subdivisions of the LAM are assigned to the medial portions of the pubococcygeus in order to reflect the attachments of the muscle to the Learning Objectives• To gain a basic knowledge on anatomy and pathophysiology of the pelvic floor unit • To get familiar with the recently published general recommendations for standardized imaging and reporting of pelvic floor disorder using MRI • To discuss how to apply these recommendations in case-based evaluations

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The Urethra and Its Supporting Structures in Women with Stress Urinary Incontinence: MR Imaging Using an Endovaginal Coil

Abstract: MR imaging with an endovaginal coil revealed significant morphologic alterations of the urethra and supporting structures in patients with stress urinary incontinence.

Cited by 81 publications

References 22 publications

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

A comparison of periurethral blood flow resistive indices and urethral closure pressure of incontinent women

Associations between obesity, physical fitness, and urinary incontinence in non-institutionalized postmenopausal women: The elderly EXERNET multi-center study

MRI of the Pelvic Floor and MR Defecography

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