Original researchUrethral sphincter morphology in women with detrusor instability
Section snippets
Materials and methods
To determine the clinical utility of this new radiologic modality for women with urinary incontinence, 130 consecutive patients underwent intraurethral ultrasonography. Urethral sphincter morphology in the stress-incontinent cohort has previously been compared with women who present with a normal urodynamic test.17 Not all women who underwent urodynamic testing had symptoms of urinary incontinence. Some had prolapse of the posterior vaginal wall and underwent urodynamic testing with their
Results
All of the patients who underwent intraurethral ultrasonography had urodynamic testing. The urodynamic diagnoses of the 130 patients were as follows: 16 were normal (12.3%), 17 had detrusor instability (13.1%), 59 had genuine stress incontinence (45.4%), 18 had genuine stress incontinence with coexistent detrusor instability (13.8%), 15 had intrinsic sphincter deficiency (11.5%), three had decreased bladder compliance (2.3%), one had overflow incontinence (0.8%), and one chart was lost (0.8%).
Discussion
This study demonstrates a clear difference in urethral sphincter morphology between patients with detrusor instability and those with normal urodynamic testing. Women with detrusor instability had a smaller total urethral diameter and circumference as a result of a loss of longitudinal smooth muscle thickness. This suggests an anatomic reason for the physiologic findings in patients with “urethrogenic” detrusor instability.
In a previous study, we found a weak positive linear association between
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Cited by (21)
Vector Flow Visualization of Urinary Flow Dynamics in a Bladder Outlet Obstruction Model
2017, Ultrasound in Medicine and BiologyCitation Excerpt :First, these vortex locations often represent the physical origin of undesired fluid pressure loss in a diseased urethra (Hou et al. 2016; Ishii et al. 2015; Ku et al. 2010; Tojo et al. 1994). Second, these vortices may alter the physical stress exerted against the urethral wall, thereby remodeling the urinary tract geometry in an undesirable way that favors the trapping of residual urine (Gustafson et al. 2004, Major et al. 2002, Ostergard 1979). Non-invasive visualization of these intra-urethral vortices, together with knowledge of the urinary tract anatomy, can potentially help clinicians to more informedly plan for surgical resection of the urethra, thereby realizing a less invasive, focal therapeutic approach to the BO obstruction problem in urethral pathology.
3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability
2012, European Journal of RadiologyCitation Excerpt :Thus dimensions of the urethra obtained in our study, being slightly bigger, may be a consequence of better hydratation and higher tension of tissues in vivo, and other local environment including the fact that in our study patients had partially or completely full bladder during examinations, which also may influence the measurements performed. The anecdotal data suggest that ultrasonographic evaluation of urethral sphincter morphology might facilitate its differential diagnosis including recognition of intrinsic sphincter deficiency, and detrusor instability [14,15]. Moreover, it could be used in patients with complex conditions as Fowler's syndrome, where the urethral sphincter has abnormal structure and its failed relaxation cause urinary retention.
Perineal Ultrasound Evaluation of Dysfunctional Voiding in Women With Recurrent Urinary Tract Infections
2008, Journal of UrologyCitation Excerpt :However, while intrinsic sphincter deficiency can easily be suggested on axial ultrasound images by loss of its normal characteristic target-like appearance, the coexistence of abnormal urethral rings and increased detrusor wall thickness might be due to functional compressive urethral obstruction caused by sphincter overactivity that is idiopathic or neurological in origin.7 In patients with detrusor overactivity a positive correlation has been observed between rhabdosphincter thickness and detrusor contraction pressure, and between rhabdosphincter thickness and urethral resistance.19 In our study all patients did not have UTIs at evaluation.
Measurement of the thickness of the urethrovaginal space in women with or without vaginal orgasm
2008, Journal of Sexual MedicineCitation Excerpt :Although the number of analyzed subjects was small, the strict selection criteria render this population unique for a study of this kind. To eliminate possible confounders and improve the reproducibility of urethrovaginal space measurements, we excluded patients with clinical and urodynamic urinary incontinence [32], idiopathic detrusor overactivity, and micturition disorders [33], as well as postmenopausal patients and those with sexual dysfunction. As female genital anatomy is affected by estrogen and androgen activity [34], we also standardized the day of menstrual cycle.
Pathophysiology of urinary incontinence
2005, Reviews in Gynaecological Practice