Vascularity of the urethra in continent women using colour doppler high-frequency endovaginal ultrasonography

Abstract

ObjectivesTo assess the urethral vascularity in continent women using colour doppler high frequency endovaginal ultrasonography (EVUS).MethodsWe recruited 61 continent women attending gynaecology clinics between July and October 2009. Exclusion criteria included symptoms of urinary incontinence, voiding dysfunction, pelvic organ prolapse or urinary tract infection. The participants underwent EVUS using high frequency (9-12 MHz) biplane transducer (type 8848 BK Medical), according to a standardised protocol. Colour Doppler US was performed in sagittal plane and in transverse plane at the level of the mid-urethra. Ten seconds video files were recorded and following vascular parameters: flow velocity (Vmix), area of the vessels (Amix), intensity of vascularity (Imix), pulsatility index (PImix) and resistance index (RImix) was evaluated.ResultsThere were 30 nulliparous (49.2%) women and 31 multiparous women (50.8%) with a mean (±SD) age of 32 (±4) and 46 (±6) years respectively. Significant impairment of vascularity was observed in multiparous patients as compared to nulliparous and was reflected by increased values of RImix (p < 0.001) and PImix (p < 0.001), and decreased values of Vmix (p < 0.001), Amix (p < 0.001), Imix (p < 0.001) in axial and midsagittal sections of the midurethra. A significant decrease of mean value ± SD of Imix- from 0.02 ± 0.02 in nulliparous to 0.005 ± 0.01 in multiparous was observed.Cronbach alpha, used to assess vascular correlations and parity demonstrated a reduction when expressed only for vascular parameters, indicating that number of deliveries is an important factor while assessing urethral vascularity.ConclusionsCompared to continent nulliparous women, continent multiparous women demonstrated a significant reduction in the vascularity parameters in all measured variables when parity was accounted for.Advances in knowledgeThis study provides the basis for further research in assessing urethral vascularity in women.

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

“…High-frequency EVUS and Pixel Flux dedicated software for the assessment of blood perfusion in various organs have been studied [5,11,14]. We have previously analysed the vascular parameters in the urethra in continent women with the use of EVUS and Pixel Flux [8].…”

“…Sixty-seven women had symptoms of SUI. Data for continent women recruited from gynaecology clinics in the same time period, but as a separate group have been published previously by our group [8]. A detailed history was taken and demographic data were collected, including age, parity, body mass index, previous gynaecological surgery and ethnicity.…”

“…However, visualisation and quantification of the flow is limited by many different biological and methodological factors. Until now, quantification of the flow was based mainly on transperineal ultrasound (TPUS) [4,5], which is limited by the use of low-frequency transducers (4)(5)(6)(7)(8), distance of the transducer from the organs examined and artefacts created by transducer pressure on the urethra and prolapse, if present.…”

“…Pixel Flux software, employed in the current study, enables analysis of five different parameters of the flow, such as intensity, velocity, Tissue Pulsatility Index (TPI), Tissue Resistance Index (TRI) in addition to the area of the vessels and its ratio to the background tissues. We have recently published the first study using this software with Doppler EVUS, to compare continent nulliparous and multiparous women [8].…”

Highlights of IUGA 37th annual meeting in Brisbane 2012

“…There was a fascinating presentation on the utility of an open configuration dynamic magnetic resonance imaging (MRI) proctogram [20], showing that erect sitting and supine MRI proctograms are similar in assessing functional and anatomical disorders of the anorectum. The best oral poster by a fellow was awarded to Dr. Farah Lone for "Vascularity of the urethra in urinary continent women using color Doppler high-frequency endovaginal ultrasonography (EVUS)" which described the impact of parity on decreasing the vascularity of the urethra [21]. The best podium presentation by a fellow was awarded to Dr. Julien Labrie who presented "Long-term results of pelvic floor muscle training or midurethral sling surgery for female moderate to severe predominant stress urinary incontinence: a randomized controlled trial" [22].…”