Urethral configuration and mobility during urine leaking described using real-time transperineal ultrasonography

Abstract

Objectives: To explore the differences in the bladder neck configuration and segmental urethral mobility in the cough stress test (CST) in supine and standing positions between women with and without stress urinary incontinence (SUI). Methods:We had a prospective study of 100 controlled women and 100 incontinent women who had a CST with TPUS. The bladder neck configuration and urethral mobility were described by urethral funneling, bladder neck descent (BND), retrovesical angle (RVA), urethral rotation angle, and urethral mobility of six points along the urethra (Vectors 1 to 6). The two groups' ultrasound findings in the two positions were compared.Results: Valid data were collected from 78 controlled women and 90 women with SUI. Significant differences were found in age and BMI (p < 0.01) between the two groups. Urethral funneling was found in 33 women (36.7%) with SUI and 5 continent women (6.4%) and altered little in the standing position. In the standing position, the mean RVA was significantly increased (160° to 179°, p<0.001) in the SUI group; The mean vector of points 1 to 6 was significantly increased in the control group (all p < 0.001). The RVA, BND, and Vectors 1 to 4 were significantly greater (all p<= 0.01) in women with SUI than without, in both positions.Conclusions: Urethral funneling was an intrinsic anatomical characteristic relative to SUI. Weak upper-and mid-urethral support and an unstable connection between the trigone and proximal urethra were the anatomical signs for SUI.

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

“…There is no doubt that this study has many limitations that need to be acknowledged. First, the TPUS was performed only in the supine position in women who were symptomatic and excluded some who might have had milder but real SUI pathology 21,22,23 . Second, women with severe pelvic organ prolapse accompanied by urinary incontinence were excluded from this study.…”

“…First, the TPUS was performed only in the supine position in women who were symptomatic and excluded some who might have had milder but real SUI pathology. 21,22,23 Second, women with severe pelvic organ prolapse accompanied by urinary incontinence were excluded from this study. The UMP in SUI with concomitant cystocele needs to be further studied.…”

Optimized electroacupuncture treatment for female stress urinary incontinence: study protocol for a multi-center randomized controlled trial

“…The change of ultrasonography of pelvic floor from baseline to week 6. The indicators include bladder neck mobility, urethral rotation angle, rectovesical angle, lowest point of bladder, urethral funnel formation, the type of bladder bulging both at rest and during a Valsalva maneuver by ultrasonography ( 17 ). Thirty patients in each group will be randomly selected for this examination.…”

Association between urethral funneling in stress urinary incontinence and the biological properties of the urethral rhabdosphincter muscle based on shear wave elastography

“…Stress urinary incontinence (SUI) refers to urine leakage with increased abdominal pressure (such as sneezing, coughing, and exercise) and has a high incidence of 24% 1 . It is well accepted that urethral hypermobility 2 and intrinsic sphincter deficiency (ISD) 3 are the main pathologic factors of SUI. ISD 4 is a dysfunction of the urethral sphincter closure system involving the urethral rhabdosphincter muscle, smooth muscle, and submucosal vessels; among them, the urethral rhabdosphincter is the essential part providing urethral closure pressure 5 .…”