Transrectal Ultrasound versus Cystography In the Evaluation of Anatomical Stress Urinary Incontinence

Abstract

Thirty-two female patients with clinical and urodynamic findings of genuine stress urinary incontinence were evaluated before and 6 months after surgery for stress urinary incontinence. Twenty-nine control patients had identical evaluations before and 6 months after surgery which did not involve the urethrovesical junction. Twenty-four patients with primary bladder instability had similar evaluations and served as a second control group. Anatomical landmarks indicating support to the urethrovesical junction were evaluated by the position of the urethra at the most dependent point in the bladder on straining and the urethral descent on straining to beneath the posterior ramus of the symphysis pubis on bead chain cystography. The urethrovesical junction drop on straining was evaluated by transrectal ultrasonography. Cystographic and ultrasonographic tests for the position of the urethrovesical junction at the most dependent position in the bladder during straining were very sensitive in women with stress urinary incontinence (94 and 87% respectively) but much less specific (45 and 48% respectively). When evaluating anatomical support to the urethrovesical junction and its descent on straining, these tests were both highly sensitive (97 and 94% respectively) and specific (76 and 96% respectively) in women with genuine stress urinary incontinence. Simple clinical tests for support of the urethrovesical junction, such as the Q tip test, are non-specific in patients with stress urinary incontinence. Transrectal ultrasonography is a simple and quick out-patient procedure. The availability of ultrasound equipment in most clinics and the high sensitivity and specificity of the test make it an attractive and cost-effective alternative to X-ray cystography in the pre-operative evaluation of anatomical support to the urethrovesical junction.

Introital ultrasonography: a comparison of women with stress incontinence due to urethral hypermobility and continent women

“…This displacement under stress happens to both continent and incontinent women; the difference between them is that incontinent women not only start from worse rest conditions but also have a greater displacement, with the subsequent failure of continence mechanisms. Nevertheless, it was already reported that changes in the bladder neck position are significantly different in continent and incontinent women [2,17,22,[24][25][26][27]. The results of the present study show that when straining, either on a Valsalva manoeuvre or, more exaggerated, during coughing, the US variables in continent women tend to approach values that suggest UI.…”

“…As an anatomical defect constitutes the basis for this dysfunction, identifying this defect would result in a better approach to treatment [1]. Many imaging techniques have been used to register the changes occurring in the urethra during stress, but ultrasonography (US) seems to have major advantages over other procedures; it is feasible, cheap, it does not involve ionizing radiation and provides at least the same amount of accurate information [2][3][4]. Moreover, US offers other possibilities, e.g.…”

Systematic review and evaluation of methods of assessing urinary incontinence

“…98,143,144 The data from these studies were combined to provide a pooled sensitivity of 0.84 (95% CI 0.76 to 0.90) and specificity of 0.86 (95% CI 0.79 to 0.91). The positive likelihood ratio associated with the pooled sensitivity and specificity is 6 (95% CI 4.72 to 7.28) and the AUC for the ROC curve corresponding to the pooled DOR is 0.94 (95% CI 0.84 to 1.00) (Figure 9).…”

“…143,144 A urethrovesical junction drop during stress of at least 1 cm was defined as the cut-off for USI. and transperineal 98,140 ) with fluoroscopy during videourodynamics.…”

Investigation of evidence-based tests which were used to evaluate and diagnose process of urinary incontinence

“…Bu çal›flmalar›n verileri bir havuzda birlikte de¤erlendirildi¤i zaman duyarl›l›¤› 0,84 ve özgüllü¤ü 0,86 olarak saptanm›flt›r (5,(52)(53)(54) .…”