The Visualized Urethral Mobility Profile in Stress Urinary Incontinence Described by Four‐Dimensional Transperineal Ultrasound

Abstract

Objectives-To describe the urethral mobility during urine leaking in stress urinary incontinence (SUI) by transperineal ultrasound (TPUS) with urethral mobility profile (UMP) analysis.Methods-This was a prospective study of 380 women who had a cough stress test (CST) with TPUS. UMP software automatically placed six equidistant points from the bladder neck (Point 1) to the external urethral meatus (Point 6) and determined their x and y coordinates relative to the symphysis pubis. Urethral mobility vector of Points 1-6 (Vectors 1-6) and the distance between the six points and the symphysis (Dist. 1-6) were calculated and compared between the two groups. The visualized UMP was created by reproducing the positions of the six points at rest and on Valsalva.Results-Valid data of 188 women with SUI and 174 continent women were analyzed. The mean age of all 362 women was 49.3 years. Mean body mass index in the SUI group was significantly increased (23.8 vs 22.2 kg/m 2 , P < .001). During CST, Vectors 1-6 and Dist. 2-6 were significantly increased (all P < .005) in the SUI group. The UMP showed the mid-urethral rotated down around the symphysis pubis. The upper urethral profile in the two groups was similar. But the gap between the mid-urethra and the symphysis was wider in the SUI group.Conclusions-The visualized UMP illustrated the mid-urethral hypermobility in SUI by showing a wider gap due to the unstable connection between the mid-urethra and the symphysis pubis.

Effect of Squeeze, Cough, and Strain on Dynamic Urethral Function in Nulligravid Asymptomatic Women: A Cross-Sectional Cohort Study

“…3). 15 This helps to validate the results of the previous study and further supports that more urethral mobility that consists of the urethra swinging around the pubic bone toward the outside of the body is associated with SUI 12,15,21 …”

“…Other studies have analyzed urethral shape using ultrasound 12,21 . Pirpiris et al 12 found that SUI was strongly associated with mobility of the midurethra in translabial ultrasound and Zhao et al 21,22 used Shek's urethra mobility profile and found similar results. The similar thread from all these analyses was that most of the mobility that was observed in SUI was focused on the middle of the urethra.…”

“…15 This helps to validate the results of the previous study and further supports that more urethral mobility that consists of the urethra swinging around the pubic bone toward the outside of the body is associated with SUI. 12,15,21 Squeeze, which represented active urethral closure, exhibited very different mechanisms compared with strain. As shown by the 2-D measurements and the FIGURE 3.…”

“…Recently urethral closure pressure has been used to classify 50% of cases; however, this leaves 50% that cannot be classified 9 . Other studies have analyzed urethral shape using ultrasound 12,21 . Pirpiris et al 12 found that SUI was strongly associated with mobility of the midurethra in translabial ultrasound and Zhao et al 21,22 used Shek's urethra mobility profile and found similar results.…”

An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9–18 months postpartum

“…Ultrasound allows for the measurement of anatomical changes, such as bladder neck mobility or segmental urethral mobility, with high reliability and repeatability (20) . Real-time anatomical change in the lower urinary tract is important for understanding the etiology of SUI, as urethral hypermobility has been implicated as the main mechanism underlying SUI (21) . The study showed a relationship between bladder neck hypermobility and SUI in patients after vaginal delivery, forceps delivery, elective cesarean section and full dilation cesarean section, with a statistical significance level of p <0.002.…”