Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients

Wlaźlak, Edyta; Kluz, Tomasz; Surkont, Grzegorz; Kociszewski, Jacek

doi:10.5603/gp.a2018.0010

Cited by 17 publications

(26 citation statements)

References 32 publications

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“…A recent report showed that the CST has high sensitivity and specificity at different bladder fill volumes [2]. Studies using clinical examinations and US imaging in the supine position have indicated that aspects of the configuration and mobility of the bladder neck and urethra, such as bladder neck hypermobility, UF and urethral length, are significantly correlated with SUI [8,9]. Actually, normal continent women may have significant mobility of the urethra.…”

Section: Discussionmentioning

confidence: 99%

“…1 and 2 ). This means that one could evaluate the configuration and mobility of the bladder neck and urethra in the CST using two-dimensional TPUS, which is inexpensive and easy to perform using a common two-dimensional abdominal US system [ 8 , 9 , 14 ]. It is clear that a CST with TPUS allows clinicians to obtain more important information during an assessment for SUI.…”

Section: Discussionmentioning

confidence: 99%

“…Evaluating the behaviour of the bladder neck and urethra in the CST is vital for improving our understanding of SUI. Anatomical changes in women with SUI, such as bladder neck mobility, funnelling and urethral mobility, have been evaluated [8,9]. However, there are limited data regarding the real-time anatomical changes that occur during urine leaking in the CST.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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Introduction and hypothesis The objective was to describe 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 (TPUS). Method We carried out prospective data collection and a retrospective data analysis of 102 women with stress urinary incontinence (SUI) who had a positive CST with TPUS in the supine and/or standing position. On TPUS, the behaviour of the bladder neck and proximal urethra was described by the urethral length, urethral funnelling, bladder neck descent (BND), retrovesical angle (RVA) and urethral rotation angle (URA). Differences between the ultrasound findings in the two positions were evaluated. Results In the 102 women, the mean age was 48 years and mean BMI was 23.8 kg/m 2. On TPUS, urine leakage was detected in the supine or standing position in 102 women and in both positions in 81. Between the two positions, significant differences were found in the URA and RVA. In the standing position, the median RVA of 166°was significantly larger than that of 133°in the supine position (p < 0.001), and the median URA of 35°was significantly smaller than that of 64°in the supine position (p < 0.001). Conclusions TPUS in both positions can be used to detect the real-time behaviour of the bladder neck and urethra in the CST. In the standing position, less rotation and more straightening of the bladder neck and proximal urethra occurred during urine leakage.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

et al. 2020

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“…In addition to standard diagnostic methods, such as cough stress test, pad test, voiding diary or urodynamic testing, ultrasonography is also likely to play an important role in the diagnosis and assessment of patients with SUI (2) . Pelvic floor ultrasound performed with transvaginal probe (PFS-TV) shows excellent and good repeatability of the obtained results (4,7,8) .…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic floor ultrasound performed with transvaginal probe (PFS-TV) shows excellent and good repeatability of the obtained results (4,7,8) . In addition to sonographic evaluation of urethral and bladder neck mobility, as well as postoperative sonographic localization of the tape, visualization of urethral funneling, which, according to different authors, may overlap with SUI in 18.6% to 100% women, is also possible (2,9) . Sonographic assessment of urethral funneling may be an important diagnostic parameter in SUI and help monitor surgical outcomes in SUI patients in the future (2) .…”

Section: Introductionmentioning

confidence: 99%

The role of TVT position in relation to the pubic symphysis in eliminating the symptoms of stress urinary incontinence and urethral funneling

Pędraszewski

Wlaźlak

et al. 2019

J Ultrason

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The introduction of suburethral sling was a breakthrough in the treatment of stress urinary incontinence in women. The method is highly effective. However, the mechanism of action of a sling and the reasons for surgical failures are not fully understood. Aim: The aim of the study was to assess the impact of sling-pubic symphysis distance on eliminating the symptoms of stress urinary incontinence and urethral funneling. Materials and methods: The analysis included 106 patients who reported 3 to 6 months after sling placement for a follow-up visit encompassing clinical examination and standard ultrasonography. We evaluated the position of sling in relation to the pubic symphysis, urethral length, as well as urethral funneling length and width. Results: Cure criteria were met by 91 patients. Elimination of urethral funneling was achieved in 76.9% (n = 70) of cured patients. Urethral funneling was still present, yet shorter by a mean of 10.2 mm (p = 0.02) than before surgery in the remaining cured patients. There was a 32.5% reduction in the mean relative length of urethral funneling (p = 0.002). No significant differences were found in the pre- and postoperative funneling width. The tape-pubic symphysis distance was lower in cured women: 23.2 mm vs. 26.1 mm in failed women (p = 0.04). Similar observations were made for cured patients with persistent urethral funneling vs. failed patients (22.47 mm vs. 26.0 mm, p = 0.027). There were no differences between cured patients without urethral funneling and cured patients with persistent postoperative funneling (23.5 mm; 22.5 mm; p = 0.417). Conclusions: Tape position in relation to the pubic symphysis is important for the elimination of stress urinary incontinence. Sling location closer to the pubic symphysis reduces the length of urethral funneling, but has no effects on its width in cured patients with persistent postoperative funneling.

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The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence

Shi

Wen

Zhao

et al. 2021

J of Ultrasound Medicine

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Objectives To investigate the association of hiatal area (HA), bladder neck mobility, and urethral mobility during the cough stress test (CST) with stress urinary incontinence (SUI). Methods This was a prospective study of 110 continent and 190 incontinent women using transperineal ultrasound. HA, bladder neck mobility, and the mobility of six points along the urethra (Vectors 1–6) were measured. The cohort was randomly divided at a ratio of 2:1 into a training cohort and a validation cohort. The correlations of HA with bladder neck mobility, urethral mobility, and SUI were tested. The predictive model was yielded by fisher linear discriminant analysis and receiver operating characteristics to assess the parameters' ability to predict SUI. Results Valid data were collected from 177 incontinent women and 105 continent women. Significant differences were identified in HA, body mass index (BMI), funneling, bladder neck mobility, and Vectors 1–6 between them. HA was positively correlated to bladder neck mobility. In the training cohort, bladder neck position on Valsalva, Vectors 3, and BMI had the area under curves of 0.74, 0.69, and 0.66 (all P < 0.001); Funneling and Vector 3 had odds ratios of 18.96 and 3.65 (all P < 0.001), for predicting SUI. The predictive model incorporating funneling, Vectors 3, and BMI provided the best performance in predicting SUI in both cohorts. Conclusion The larger the HA was, the higher the bladder neck mobility. However, it was mid‐urethral mobility rather than bladder neck mobility that performed best at predicting SUI.

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Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients

Abstract: Long urethral funneling (> 50% of urethral length) seems to be a characteristic sign for SUI in women. The presence of urethral funneling shorter than 50% of urethral length (short urethral funneling) is not a SUI symptom - it is probably a sign of asymptomatic funneling of bladder neck.

Cited by 17 publications

References 32 publications

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

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

The role of TVT position in relation to the pubic symphysis in eliminating the symptoms of stress urinary incontinence and urethral funneling

The Association of Hiatal Dimensions and Urethral Mobility With Stress Urinary Incontinence

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