Introitus- und Perinealsonographie in der Diagnostik der Stressharninkontinenz - Möglichkeiten der klinischen Anwendung

Abstract

Urogynecological ultrasound as a part of the diagnostic work-up of stress urinary incontinence enables the morphologic and dynamic assessment of the lower urinary tract and has replaced radiography in the primary diagnostic work-up of stress urinary incontinence. It is possible to classify the sonographically identified changes of the endopelvic fascia, whereby any dynamic changes must be interpreted in context with the clinical findings. Stress urinary incontinence, besides voiding dysfunction, recurrent urinary tract infections and dyspareunia, may be associated with urethral diverticula, which can be detected by ultrasound. Postoperative voiding problems, de novo urgency or recurrent urinary tract infections can be assessed by demonstrating possible causes, such as haematomas, overcorrection with postvoid residual, misplacement of the tape at the level of the bladder neck or intravesical displacement of suture or tape material. Introital and perineal ultrasound might also be used for monitoring the proper placement of sutures to reduce postoperative complications.

EFSUMB Recommendations for Gastrointestinal Ultrasound Part 3: Endorectal, Endoanal and Perineal Ultrasound

“…The ultrasound transducer is placed above the external aperture of the urethra in women, which allows imaging of the urethra and the posterior wall of the urinary bladder. The degree of uterine prolapse can be estimated from the delta angle between both structures at rest and during a Valsalva maneuver 139 .…”