Dynamic magnetic resonance imaging of the behavior of the mid‐urethra in healthy and stress incontinent women

Abstract

Elevation of the mid-urethra was more marked in continent compared to urinary incontinent women on pelvic floor muscle contraction suggesting sufficient support of the urethra. Downward movement of the mid-urethra was more significant in stress incontinent women than in continent volunteers.

Urethral pressure reflectometry during intra‐abdominal pressure increase—an improved technique to characterize the urethral closure function in continent and stress urinary incontinent women

“…The presented results which were obtained from HPZ measurements support the theory that mid‐urethral mobility rather than bladder neck mobility seems to be most strongly affected in SUI cases, suggesting impaired support of this part of the urethra. This is in agreement with early proposed theories of the pubo‐urethral ligament acting as a central fulcrum between the bladder and the external urethral meatus: when the bladder descends caudally during intra‐abdominal pressure increase the urethra is subsequently compressed at its mid‐point.…”

Dynamic MRI confirms support of the mid-urethra by TVT and TVT-O surgery for stress incontinence

“…The two different measurements were done in 15 healthy volunteers and in the first 20 stress urinary incontinent women. The results of the two different ways of measurements did not differ from each other (10). As the bladder neck could be more precisely determined, the distance of 15mm from the bladder neck was used as the point of the mid‐urethra in the study.…”

“…Sixteen healthy, parous volunteers with no urinary symptoms (10) and 42 women with diagnosed stress urinary incontinence were recruited for a dynamic MRI study. The study groups were healthy, continent women and women scheduled for a mid‐urethral sling operation for treatment of urinary stress incontinence.…”

“…Dynamic magnetic resonance imaging (MRI) is a more recent method, much more expensive than ultrasound but for certain aspects more accurate (8,9). We have previously assessed mobility of the mid‐urethra in healthy continent volunteers and stress incontinent women with dynamic MRI during different maneuvers and found significant differences in movement ability (10).…”

Assessment of urethral support using MRI-derived computational modeling of the female pelvis

“…Many studies have investigated the pathophysiology of SUI through medical imaging techniques such as ultrasonography [4], anatomical magnetic resonance (MR) imaging [5–7] and dynamic MR imaging [8–10]. To assess urethral hypermobility caused by isolated impairment of each specific USS component and to compare the components’ relative contribution to urethral support function would require the recruitment of patients with only one impairment condition, which is clinically challenging to identify clinically.…”