The Evaluation of Posterior Urethrovesical Angle, Urethral Length, Bladder Wall Thickness, and Residual Volume with Transperineal Ultrasonography in Women with Urinary Incontinence

Year 2021, Volume: 7 Issue: 3, 312 - 319, 31.12.2021

Nihal Çallıoğlu Keziban Doğan , Cemal Ark Sema Baghakı

https://doi.org/10.19127/mbsjohs.911429

Abstract

Objective: In the recent decades, transperineal ultrasonography has been used to examine patients in urogynaecology practice. In this study, we aimed to evaluate the function of transperineal ultrasonography in women with urinary incontinence.
Methods: Forty-five patients who were admitted to our institution between December 2012 and May 2013 and clinically and urodynamically diagnosed as having urinary incontinence (SUI n=20, DI+UUI n=13, MUI n=12) were included in the study. Additionally, 25 clinically and urodynamically continent women were included as the control group.
The patients were evaluated using transperineal ultrasonography (USG) in the supine position during rest and straining. An abdominal probe was placed in the perineum vertically and sagittally; when the symphysis pubis, urethra, bladder, vagina, and rectum could be seen clearly on the monitor, the image was frozen. Posterior urethrovesical angle (PUVA), urethral length, bladder wall thickness, and residual urine volume were measured on the image. All measurements were compared statistically between the SUI, UUI, MUI groups, and control group. The post-void residual volume measured using transperineal ultrasonography was compared with the post-void residual volume measured using a catheter during urodynamics.
Results: PUVA was significantly different in the SUI and MUI groups at rest than in the control group (p<0.05). During Valsalva maneuvers, PUVA was statistically significantly different in the SUI and MUI groups than in the UUI and control groups (p<0.01).
Conclusion: The measurement of PUVA and bladder wall thickness by transperineal ultrasonography is shown to be useful in diagnosis of patients with suspected detrusor instability and structural defects in pelvic floor. Therefore, transperineal USG may be an easy and reliable method which could be an alternative to urodynamic studies in patients who cannot undergo urethral catheterization.

Keywords

urinary incontinence, ultrasonography, urinary sphincter

References

• 1. Abrams P, Cardozo L, Fall M, et al. The standardization of terminology in lower urinary tract function: report from the standardization subcommittee of the International Continence Society. Urol J 2003;61:37–49.
• 2. Morrill M, Lukacz ES, Lawrence JM, et al. Seeking healthcare for pelvic floor disorders: a population-based study. Am J Obstet Gynecol 2007;197:86.e1.
• 3. Hannestad YS, Rortveit G, Hunskaar S. Help-seeking and associated factors in female urinary incontinence. The Norwegian EPINCONT Study. Epidemiology of Incontinence in the County of Nord-Trøndelag. Scand J Prim Health Care 2002; 20:102.
• 4. Subak LL, Richter HE, Hunskaar S. Obesity and urinary incontinence: epidemiology and clinical research update. J Urol 2009; 182:S2.
• 5. Rortveit G, Hannestad YS, Daltveit AK, Hunskaar S. Age- and type-dependent effects of parity on urinary incontinence: the Norwegian EPINCONT study. Obstet Gynecol 2001; 98:1004.
• 6. Lukacz ES, Lawrence JM, Contreras R, Nager CW, Luber KM. Parity, mode of delivery, and pelvic floor disorders. Obstet Gynecol 2006; 107:1253.
• 7. Lawrence JM, Lukacz ES, Liu IL, Nager CW, Luber KM. Pelvic floor disorders, diabetes, and obesity in women: findings from the Kaiser Permanente Continence Associated Risk Epidemiology Study. Diabetes Care 2007; 30:2536. 8. Abrams P, Cardozo L, Fall M, et al. The standardization of terminology of lower urinary tract function: report from the standardization sub-committee of the International Continence Society. Neurourol Urodyn 2002;21:167–78.
• 9. Wood LN, Anger JT. Urinary incontinence in women. BMJ 2014;349: g4531 10. Karram MM, Bhatia M. The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. Obstet Gynecol 1988;71(6 Pt 1):807– 811.
• 11. Mc Guire EJ, Lytton B, Pepe V, Kohorn EI. Stress urinary incontinence. Obstet Gynecol 1976;47(3):255–264.
• 12. Koelbl H, Strassegger H, Riss PA, Gruber H. Morphologic and functional aspects of pelvic floor muscles in patients with pelvic relaxation and genuine stress incontinence. Obstet Gynecol 1989;74(5):789– 795.
• 13. Benson JT, Sumners JE, Pittman JS. Definition of normal female pelvic floor anatomy using ultrasonographic techniques. J Clin Ultrasound 1991;19(5):275– 282.
• 14. Johnson JD, Lamensdorf H, Hollander IN, Thurman AE. Use of transvaginal endosonography in the evaluation of women with stress urinary incontinence. J Urol 1992;147(2):421–425.
• 15. Kohorn EI, Scioscia AL, Jeanty P, Hobbins JC. Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet Gynecol 1986;68(2):269–272.
• 16. Dietz HP, Clarke B. Translabial color Doppler urodynamics. Int Urogynecol J Pelvic Floor Dysfunct 2001;12(5):304-7.
• 17. Buthon G. Pad weighing test. in; urogynecology. Cordozo L (ed.) Churchill Lvingstone, New York, 199; s: 135-140.
• 18. Artibani E, Andersen JT, Gajewski JB, Ostegard DR, Raz S, Tubaro A. Imaging and other investigations. In:Abrams P, Cardozol L, Khoury S, Wein A, editors. Incontinence. Plymouth (UK):Plymbridge Distributors Ltd; 2002:425-477
• 19. Hartnell GG, Kiely EA, Williams G. Real-time ultrasound measurement of bladder volume: A comparative study of three methods. Br. J. Radiol. J. Urol. 1983; 130; 249- 51. 20. Green JH. Develoment of a plan for the diagnosis and treatment of urinary stress incontinence. Am J Obstet Gynecol. 1962;83;632-648.
• 21. Koelbl H, Bernaschek G, Wolf G. A comparative study of perineal ultrasound scanning and urethrocystography in patients with genuine stress incontinence. Arch Gynecol Obstet. 1988:244:39-45. 22. Alper T, Çetinkaya M, Okutgen S, Kökçü A, Malatyalıoğlu E. Evaluation of urethrovesical angle by ultrasound in women with and without urinary stress incontinence. Int Urogynecol J 2001; 12:308-311.
• 23. Sendag F, Vidinli H, Kazandi M, et al. Role of perineal sonography in the evaluation of patients with stress urinary incontinence. Aust NZJ Obstet Gynaecol. 2003;43(1):54-7.
• 24. Pizzoferrato AC, Fauconnier A, Bader G. Value of ultrasonographic measurement of bladder neck mobility in the management of female stress urinary incontinence. Gynecol Obstet Fertil. 2011 Jan;39(1):42-8. 25. Hu Y, Lou Y, Liao L, et al. Comparison of urodynamics and perineal ultrasonography for the diagnosis of mixed urinary incontinence in women. J Ultrasound Med. 2018 Nov;37(11):2647-2656. 26. Yalçin ÖT, Şener T, Hassa H, Özalp S, Yıldırım A. The efficacy of the posterior urethro-vesical angle measurement for diagnosing the type of urinary incontinence. Turkiye Klinikleri J. Gynecol Obst 1996;6(4):316-20.
• 27. De Souza NM, Daniels OJ, Williams AD, Gilderdale DJ, Abel PD. Female urinary genuine stres incontinence: Anatomic considerations at MR imaging of the paravaginal fascia and urethra-initial observations. Radiology 2002;225:433-439
• 28. Oelke M, Khullar V, Wijkstra H. Review on ultrasound measurement of bladder or detrusor wall thickness in women: techniques, diagnostic utility, and use in clinical trials. World J Urol. 2013 ;31(5):1093-104.
• 29. Abou-Gamrah A, Fawzy M, Sammour H, Tadros S. Ultrasound assessment of bladder wall thickness as a screening test for detrusor instability. Arch Gynecol Obstet. 2014;289(5):1023-8. 30. Panayi DC, Khullar V, Fernando R, Tekkis P. Transvaginal ultrasound measurement of bladder wall thickness: a more reliable approach than transperineal and transabdominal approaches. BJU Int. 2010 ;106(10):1519-22.
• 31. Yeniyol CÖ, Çiçek S, Çiçek E, Zeyrek N, Arslan M, Ayder AR. Abdominal ultrasound versus urethral catheterisation in the measurement of residual urine volume. Turkish Journal of Urology; 27(1): 56-58, 2001.
• 32. Dinçel Ç, Akbulut H, Islim F et al. Residual urine measurements: Comparison between transabdominal ultrasonography and urethral catheterisation. Turkish Journal of Urology; 25(3): 314-318,1999
• 33. Kiely EA, Hartnell GG, Gibson RN, Williams G. Measurement of bladder volume by real-time ultrasound. Br J Urol. 1987;60(1):33-5.