The Combined Use of Perineal Ultrasound and MR Imaging in the Evaluation of Stress Urinary Incontinence
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- Category: Vol. 85, September 2017
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The Combined Use of Perineal Ultrasound and MR Imaging in the Evaluation of Stress Urinary Incontinence, MARWA S.A. EL-NAFRAWY and AHMED ZAKARYA
Abstract
Background: Stress Urinary Incontinence (SUI), can be due to intrinsic sphincter deficiency or hypermobility of the bladder neck or urethra.
Aim of Work: This study aimed at assessing the comple-mentary role of Ultrasound (US) and Magnetic Resonance Imaging (MRI) in those patients.
Material and Methods: Thirty female patients (mean age: 42 years old) with an established clinical diagnosis of SUI and 5 female volunteers (mean age: 43 years old) underwent perineal US and MRI (static and dynamic). The US evaluation included measurement of the bladder wall thickness, detrusor muscle thickness, urethral length and thickness and assessment of the retrovesical angle at rest and with strain. At MRI, descent of the bladder below the pubococcygeal line, levator plate orientation, vaginal configuration, puborectalis muscle and levator hiatus width were assessed.
Results: MRI study showed that there was statistically significant (p<0.05) elongation of H line at rest and with pelvic strain (mean: 6.43 versus 4.71cm in controls at rest and 7.69 versus 5.20cm with strain respectively), widening of the elevator hiatus (4.17cm versus 3.20cm in controls) and puborectalis abnormalities (in 55% of patients). On trans-vaginal US, there was statistically significant increased detrusor muscle thickness (mean: 0.16 versus 0.12cm in controls), shortened urethral length (2.74 versus 3.17cm in controls) and increased retrovesical angle with strain (140º versus 121º in controls).
Conclusion: A combined approach of 2D perineal US and MRI assessment can lead to more successful management of patient with SUI and subsequently decreases the rate of postoperative recurrence.