Reliability of Voiding Colpo-Cysto-Urethrography in Female Urinary Stress Incontinence before and after Treatment

Abstract

Voiding colpo-cysto-urethrography was performed in 52 consecutive female patients with genuine urinary stress incontinence before treatment and in 50 of the patients after treatment. The patients were randomized to either pelvic floor training or surgery. Surgery included a colposuspension operation in patients with an anterior suspension defect and a vaginal repair in patients with a posterior suspension defect. All pre-and posttreatment examinations were reevaluated blindly by one observer 4 to 6 years later. The pretreatment radiologic reevaluation was in agreement with the original classification in 79 per cent and not in agreement in 21 per cent. Pelvic floor training did not change the degree of suspension defect systematically. The effect of squeezing was significantly improved following pelvic floor training. A colposuspension gave rise to a typical radiologic configuration of the bladder and urethra. A vaginal repair was not detectable radiologically and it did not correct a posterior descent. The degree of descent and the degree of incontinence were not correlated and it was not possible radiologically to distinguish treatment failures from treatment success.

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

“…Traditional surgical procedures for treatment of female stress urinary incontinence (SUI), like colposuspension and slings, have aimed at restoring anatomy of a hypermobile bladder neck. Radiographic and sonographic studies have focused on the identification and quantification of this hypermobility as a cause of incontinence revealing poor correlation between symptoms and findings (4–8). The new minimally invasive mid‐urethral tape procedures have been shown to be as effective or even more effective than the traditional methods in curing stress incontinence (9–11).…”

The role of imaging in urinary incontinence

“…The specificity is 44–76% and the sensitivity 53–100%[14,15]. Because the degree of SUI does not correlate with the type or degree of suspension defects [16,17], VCUG cannot be recommended for diagnosing or classifying urinary incontinence. Moreover, is not possible to distinguish postoperative failures from success [15,18–20].…”

Role of imaging in urogynaecology

“…Instilling contrast with or without the use of a bead chain to delineate the urethra has been used in an attempt to diagnose the causes of lower urinary tract dysfunction. Unfortunately this technique cannot discriminate between stress incontinent and continent women 1–4 . The specificity in diagnosing urodynamic stress incontinence using static bead chain cystourethrography is between 44% and 76% with a sensitivity of 53%–100% 13 .…”

“…Bladder neck mobility is also poorly demonstrated with VCUG 5,9 with a positive predictive value of 0.56 and a negative predictive value of 0.74. Postoperative changes to the bladder neck are not seen after vaginal repairs but colposuspension does produce changes in the position of the bladder neck which can be seen with X‐ray screening, 6 but this does not predict success or failure of the colposuspension 2,5,7–12 . It is also not possible to distinguish postoperative failures from success 2,5,8–13 .…”

“…It is also not possible to distinguish postoperative failures from success 2,5,8–13 . Colposuspension produces a typical image of the bladder neck being pulled forwards towards the back of the symphysis pubis and pelvic floor training improves the ability of the women to contract their pelvic floor and thereby compress the urethra, but there is no suspension effect 6 …”