Colour Doppler ultrasonography of female urethral vascularization in normal young volunteers: a preliminary report

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.

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

“…Our study was designed to identify a correlation between blood supply and urethral pressure profiles, specifically the MUCP. As found in Siracusano et al's study [23,24] on normal volunteers, our indices were best calculated at the segment closest to the external meatus, where the vascularity was most consistently well seen. Although we were able to reproduce the Doppler waveform RI of the periurethral vasculature, we were not able to correlate RI measurements with either complaints of incontinence or urethral pressure measurements.…”

“…An additional study done by the same investigator evaluated the resistive index of blood flow surrounding the urethra in healthy young continent patients. This study demonstrated that there is a significantly greater resistive index in the anterior proximal urethra than in the distal and middle urethra [23,24]. Others have hypothesized that normal urethral vascularity contributes up to 30% of the total closure pressure [25].…”

Vascularity of the urethra in continent women using colour doppler high-frequency endovaginal ultrasonography

“…RI was not correlated with parity (Hall et al 2006). In the study by Siracusano et al (Siracusano et al 2001) colour doppler ultrasound of the female urethra in normal fertile young women identified a significantly greater RI in the proximal urethra compared to the middle and distal urethra. Similar results were obtained in the studies by Yang et al (Yang et al 2006) and Wieczorek et al (Wieczorek et al 2011) However all authors emphasised that the differences in obtained RI values may result from general limitations of doppler flow analysis in the urethra.…”

“…The values of vascular parameters in the different parts of the urethra have been measured using various techniques (Scholbach et al 2006; Siracusano et al 2001). In the pioneering study by Wieczorek et al, on quantitative assessment of urethral vascularity in nulliparous women, compared to the other parts of the urethra, the midurethra appeared to have the highest value of V mix and the lowest value of A mix.…”

The feasibility of urethral color ultrasound imaging in the diagnosis of female intrinsic sphincter deficiency: preliminary results

“…7 In the present study, in some patients, the ecographic score did not correlate with the MCUP and this ®nding could be an indication that sometimes the UPP is of limited practical value while color ultrasound imaging of the female urethra allowed visualization and classi®cation, using a subjective US score, of the urethral arterial vascularization of normal volunteers and patients a ected by ISD.…”