Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound

Wen, Liang; Zhao, Baihua; Chen, Wenjie; Qing, Zhenzhen; Liu, Minghui

doi:10.1007/s00192-020-04273-w

Cited by 14 publications

(27 citation statements)

References 22 publications

(38 reference statements)

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“…As bladder pressure is higher in standing than sitting or supine, 12 and standing reduce support from the perineum, maintenance of continence is likely to be more challenging in this body position. This has been reported for women, 13 and suggested, although not shown, in men. 11 Recent work using TPUS has shown that position and displacement (with contraction) of pelvic landmarks associated with PFM contraction differs between sitting and standing.…”

Section: Introductionsupporting

confidence: 56%

The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction

Cowley

Stafford

Hodges

2021

Neurourology and Urodynamics

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To compare pelvic floor muscle (PFM) anatomy and function (i) between pre-and post-prostatectomy in standing, and (ii) between sitting and standing postprostatectomy. Methods: Thirty-two men scheduled to undergo a prostatectomy volunteered to participate. Transperineal ultrasound imaging was used to visualize five anatomical pelvic landmarks that have been validated to reflex anatomy and activity of PFMs (pubic symphysis, anorectal junction [ARJ], mid-urethra [MU], bulb of penis [BP], and urethrovesical junction [UVJ]). Both before and after prostatectomy, participants performed three submaximal PFM contractions in sitting and/or standing positions while ultrasound data were recorded.Results: Postprostatectomy the UVJ location was more caudal and dorsal, the ARJ (puborectalis) vector was longer, the BP was more ventral than preprostatectomy, and these landmarks moved less ventrally with contraction. After prostatectomy, the MU, BP, and ARJ were more ventral in standing than sitting. The UVJ was more caudal and elevated more with contraction in standing than sitting after prostatectomy. Conclusion:These data demonstrate differences in the anatomy and mechanics of PFMs post-versus pre-prostatectomy, and between sitting and standing positions postprostatectomy. Findings are consistent with surgical changes to the bladder and urethral anatomy. Reduced passive support for the urethra and bladder are likely to may contribute to differences between standing and sitting postprostatectomy.

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Section: Introductionsupporting

confidence: 56%

The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction

Cowley

Stafford

Hodges

2021

Neurourology and Urodynamics

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“…Although in the standing position the structures of the anterior compartment lie lower than in the lithotomy position, the differences are small and not of clinical signi icance [8]. The relative bladder neck mobility itself is shown not to be affected by the examination position [9,10].…”

Section: Patient Population and Proceduresmentioning

confidence: 86%

Establishment of a new reference line for 2D transperineal ultrasound in urogynecology

Dionysopoulou¹,

Skala²,

Weiß³

et al. 2020

Clin J Obstet Gynecol

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Background: The purpose of this study was to establish a new, reliable and reproducible reference line for assessing bladder neck descent using 2-dimensional transperineal ultrasound. Therefore, we created a novel line, named Symphysis-Levator Line (SLL) and defi ned it as the connecting line between the hyperechogenic, dorsocaudal edge of the symphysis pubis and the hyperechogenic anterior margin of the puborectalis muscle, posterior to the anorectal junction. Methods: A retrospective study was performed including 111 patients, who underwent a transperineal ultrasound as part of an urogynecological examination in the department of Urogynecology at the University Medical Center of the Johannes Gutenberg University Mainz. We calculated the bladder neck decent using the SLL and compared our results with the measurements assessed using a horizontal line through the infero-posterior margin of the symphysis pubis, as previously described by Dietz (Horizontal Symphysis Line, HSL). In addition, we calculated the intra-and interobserver reliability of the two methods and examined the infl uence of various patient characteristics on the obtained values. Results: Both methods demonstrated a high intra-and interobserver reliability. Even though the HSL produced slightly higher numerical values for the bladder neck descent, the novel SLL was more precise. Our data support that the 2-point fi xation of the SLL on two anatomical structures ensures the stability of the reference plane during the functional changes of the pelvic fl oor. Conclusion: The Symphysis-Levator Line could be a useful tool for urogynecologists in the future.

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“…Previous studies showed transperineal ultrasound could record real-time urine leakage and describe the anatomic changes in SUI. There were differences regarding bladder neck configuration and mobility during urinary leakage in supine and standing positions [3]. However, the mid-urethral mobility rather than the bladder neck mobility may account for SUI [11].…”

Section: Zusammenfassungmentioning

confidence: 92%

Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions

et al. 2022

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Objectives To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions. Method This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap. Results Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group. Conclusion The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.

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Real-time assessment of the behaviour of the bladder neck and proximal urethra during urine leaking in the cough stress test (CST) in supine and standing positions using transperineal ultrasound

Cited by 14 publications

References 22 publications

The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction

The influence of prostatectomy and body position on location and displacement of pelvic landmarks with pelvic floor muscle contraction

Establishment of a new reference line for 2D transperineal ultrasound in urogynecology

Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions

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