Factors affecting urethrocystographic parameters in urinary continent women

Journal of Ultrasound in Medicine

2002

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Objective. To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. Methods. Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. Results. Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. Conclusions. Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability. Key words: lower urinary tract symptoms; ultrasonography; urodynamics. Abbreviations HB, hypersensitive bladder; DI, detrusor instability; GSI, genuine stress incontinence; LUTS, lower urinary tract symptoms emale lower urinary tract symptoms (LUTS) are present in a heterogeneous group of disorders with varied pathogenesis. Because urinary symptoms are diagnostically unreliable, 1 it is appropriate to use urodynamic investigation and imaging studies as an integral part of evaluation of lower urinary tract disorders. Currently, videocystourethrography is a tool that simultaneously offers both urodynamic and anatomic assessment of the lower urinary tract. However, it is not widely available because of its sophistication and concerns about radiation exposure. Ultrasonography, which is noninvasive, easily reproducible, and without radiation, has replaced radiologic methods in anatomic evaluation of the lower urinary tract. [2][3][4][5][6]

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Discrimination of Bladder Disorders in Female Lower Urinary Tract Symptoms on Ultrasonographic Cystourethrography

Journal of Ultrasound in Medicine

2002

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“…Unlike with prolapse, with an impacted pelvic mass the urethrovesical junction was at a normal level behind the symphysis pubis, and urethral mobility was not restricted. 5 In our patients, it was the anteriorly and superiorly displaced cervix that compressed the lower bladder and interfered with drainage into the urethra. The urethra itself was not compressed or attenuated.…”

Section: Discussionmentioning

confidence: 99%

Sonographic Findings of Acute Urinary Retention Secondary to an Impacted Pelvic Mass

J of Ultrasound Medicine

2002

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Objective. To describe the sonographic findings in a series of cases of acute urinary retention due to an impacted pelvic mass. Methods. The anatomic changes of the lower urinary tract in 6 patients with impacted pelvic masses and acute urinary retention (3 cases of an impacted uterine leiomyoma and 3 cases of a retroverted gravid uterus) were evaluated with transabdominal and transvaginal sonography. Results. When patients were in the supine position, the impacted pelvic masses displaced the cervix superiorly and anteriorly, compressing the lower bladder, leading to obstruction of the internal urethral orifice. During straining, there was no limitation of urethral mobility, but the increased abdominal pressure further compressed the lower bladder. When the subjects stood, the lower bladder filled with urine. There was descent of the bladder neck, and obstruction was relieved. Conclusions. Acute urinary retention in cases of an impacted pelvic mass is caused by a displaced cervix compressing the lower bladder, obstructing the internal urethral orifice. The urethra itself is not compressed or distorted.

“…Ultrasonographic evaluation was performed with patients in a supine position with a comfortably full bladder by using a transvaginal ultrasound with a Toshiba SSA-260A scanner (Tokyo, Japan ) and a 5.0 MHz vaginal probe. The degree of anterior vaginal wall relaxation was determined by quantitative measurement of the bladder neck position at rest and during a maximumValsalva maneuver [Yang, 1996] and qualitative documentation of the presence of a cystocele, i.e., a prolapse or herniation of the bladder base below the urethrovesical junction at rest or during Valsalva maneuver.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with voiding function in women with lower urinary tract symptoms: A mathematic model explanation

Neurourology and Urodynamics

2003

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