Ultrasound Characteristics of Patients with Urinary Stress Incontinence with or without Genital Prolapse

Abstract

Purpose: The study purpose was to evaluate the clinical and ultrasound characteristics of women with urinary stress incontinence (USI) with or without genital prolapse (GP).

Materials and methods: A total of 268 patients who underwent ultrasound perineal evaluation were divided into two groups: isolated USI (n=132) and USIGP (n=136) with USI/GP stage I/II. The latter group was additionally divided into two subgroups: USIGP(A) (n=78) with USI/GP stage I and USIGP(B) (n=58) with USI/GP stage II.

Results: Point Aa (pelvic organ prolapse quantification system), which is the projection of the bladder neck (BN) on the anterior vaginal wall, was situated higher in the rest position (RP) but moved lower during a Valsalva maneuver (VM) in the USI group than in the USIGP group (p<0.05). The ultrasound parameters α-angle and the distance Sy-BN (symphisis-bladder neck) decreased, whereas distance H increased, in the USIGP group during VM. The ultrasound parameters that gave the best insight into the range of BN movements were as follows: distance R→V and angle of rotation (ρ), which were significantly higher in the USI group than in the USIGP group during VM.

Conclusions: According to the clinical and ultrasound findings, we can conclude that the BN is situated higher during the RP but moved lower during a VM in patients with isolated USI compared with those with concomitant USI/GP, which could be explained by the cystocele-immobilizing effect on the BN during the VM in the latter group but also by the deteriorated pubo-urethral ligaments in the former group.

Keywords: POP-Q; Pelvic organ prolapsed; Ultrasonography; Urinary incontinence stress.

FIG. 1

Ultrasound evaluation of patients with isolated urinary stress incontinence during the rest position, maximal pelvic floor contraction, and a Valsalva maneuver.

FIG. 2

Ultrasound evaluation of patients with urinary stress incontinence and genital prolapse stage I/II during the rest position, maximal pelvic floor contraction, and a Valsalva maneuver.

FIG. 3

Model of pelvic organ position during Valsalva maneuver vs. rest position in patients without urinary stress incontinence or genital prolapse. Dx, the distance between bladder neck (BN) and y-axis; Dy, the distance between BN and x-axis; Sy-BN, the distance between BN and inferior symphysis border; Distance-H (the height of BN), the distance between BN and horizontal line, which is drawn at the lower symphysis border; Distance R→V=(Vx-Rx)²+(Ry-Vy)², angle of rotation-(ρ)=(cotangent Ry/Rx)-(cotangent Vy/Vx); Pubourethral angle-(α)- the distance between Sy-BN and x-axis, retrovesical angle-(β)- the angle for which one side lies along the line connecting the dorsocaudal and proximal urethra and the other side is formed by the tangent along the bladder base.

FIG. 4

Model of the possible movements of pelvic anatomical elements during Valsalva maneuver vs. rest position in patients with isolated urinary stress incontinence. Dx, the distance between bladder neck (BN) and y-axis; Dy, the distance between BN and x-axis; Sy-BN, the distance between BN and inferior symphysis border; Distance-H (the height of BN), the distance between BN and horizontal line, which is drawn at the lower symphysis border; Distance R→V=(Vx-Rx)²+(Ry-Vy)², angle of rotation-(ρ)=(cotangent Ry/Rx)-(cotangent Vy/Vx); Pubourethral angle-(α)- the distance between Sy-BN and x-axis, retrovesical angle-(β)- the angle for which one side lies along the line connecting the dorsocaudal and proximal urethra and the other side is formed by the tangent along the bladder base.

FIG. 5

Model of the possible movements of pelvic anatomic elements during Valsalva maneuver vs. rest position in patients with urinary stress incontinence and genital prolapse stage I/II. Dx, the distance between BN and y-axis; Dy- the distance between BN and x-axis; Sy-BN- the distance between bladder neck (BN) and inferior symphysis border; Distance-H (the height of BN), the distance between BN and horizonotal line, which is drawn at the lower symphysis border; Distance R→V=(Vx-Rx)²+(Ry-Vy)², angle of rotation-(ρ)=(cotangent Ry/Rx)-(cotangent Vy/Vx); Pubourethral angle-(α)- the distance between Sy-BN and x-axis, retrovesical angle-(β)- the angle for which one side lies along the line connecting the dorsocaudal and proximal urethra and the other side is formed by the tangent along the bladder base.