Perineal ultrasound evaluation of the urethrovesical junction angle and urethral mobility in nulliparous women and women following vaginal delivery

Abstract

The objective of this study was to demonstrate the differences in the urethrovesical junction angle and urethral mobility by means of perineal ultrasounds in women following vaginal delivery with respect to nulliparous women. We have enrolled 34 women, 12 nulliparous (Group A) and 22 women in the post-partum period (Group B). The ultrasounds were employed to measure the urethrovesical junction angle ("urethro-pelvic" angle) and the urethral mobility. Data obtained show that the urethro-pelvic angle is narrower in Group A (97.3 degrees) with respect to Group B (112.5 degrees). Urethral mobility while coughing was significantly higher in Group B (30.4 degrees) with respect to Group A (-2 degrees). This study demonstrates the difference in the urethral support at rest and during cough in nulliparous versus recently delivered parous women.

Investigation of optimal cues to instruction for pelvic floor muscle contraction: A pilot study using 2D ultrasound imaging in pre‐menopausal, nulliparous, continent women

“…Pre‐pilot study observations indicated that precisely identifying the margins of the bladder neck was more problematic than identifying the urethral lumen and therefore the AUI was chosen as the measurement index. A previous study reported the AUI to be an easily identifiable and reproducible index8 and a significant correlation between bladder neck and AUI parameters has been previously demonstrated 25. The levels of reliability between the two readers in this study further support the use of AUI in this and in future studies.…”

“…Other published instructions may not facilitate recruitment of all regions of the pelvic floor musculature and rather concentrate the lift around the vagina. These include “draw in, close around the vagina and lift the pelvic floor up toward the head”7; or around the urethra “mimic the interruption of micturition”8; or indeed not specifically within the pelvic floor at all such as “squeeze your buttocks together.”9 Thus, differing cues to instruction (Table I) may facilitate greater or lesser recruitment of a particular region of the PFM, thereby variously influencing position of urethrovesical structures with respect to continence.…”

Rehabilitative Ultrasound Imaging: Understanding the Technology and Its Applications

“…Furthermore, USI has been used to describe the relationship between the pelvic floor muscles and the bladder wall, 131,133 the bladder neck and symphysis pubis, 106 the bladder neck and anorectal angle, 98,99 as well as the bladder base and the urethrovesical neck. 21 As an extension of this work, investigators have been able to demonstrate acceptable interrater and intrarater reliability for various measurement applications, 18,74,88,117,129 to generate normal reference ranges, 104,105,120 to demonstrate differences in these parameters over time between normal and various patient cohorts 51,100,130,133 as a result of therapeutic interventions, 50 and to investigate the relationship between the size and strength of specific muscles in varied populations. 4,67,88,145,146 Recently, the role that b-mode USI has played in detecting the presence of muscular degeneration resulting from aging and/or chronic dysfunction has been investigated.…”

Characteristics of the pelvic floor during pregnancy by 2D and 3D ultrasound

“…These changes reflect the fact that pregnant women have a smaller Hye Ri Hong, et al Characteristics of the pelvic fl oor during pregnancy by 2D and 3D ultrasound hiatal area than non-pregnant women. Morphological changes in the levator hiatus may have clinical signifi cance in the subsequent development of urinary incontinence and pelvic organ prolapsed [16,21]. The levator ani muscle is thought to play a signifi cant role in the pathogenesis of these highly prevalent conditions and it is estimated that parous women have an increased lifetime risk (by age 80) of undergoing surgical treatment for one of these conditions [22].…”