Numerous anatomical theories have been developed to explain women stress urinary incontinence (SUI) and improve its management. The transperineal ultrasound is an efficient and non-invasive exam that perfectly studies the bladder neck movement and the urethral anatomy. The measurement of the static portion of the distal urethral length, considered as the functional urethral length (FUL), and of the posterior urethral closure angle (PUCA) have not been studied before and could be of interest.
This prospective case control study compared incontinent and continent patients. Bladder neck descent, FUL and the PUCA were measured at rest and then during Valsalva maneuvers. The correlation between these perineal sonographic criteria and the severity of incontinence was then evaluated.
Fifty patients were included in the study. Bladder neck descent during Valsalva maneuvers was higher in the incontinence group (22.8mm versus 13.5mm, p=0.001). There was not any significant difference in the two groups concerning the FUL and PUCA. Bladder neck descent (ρ=0.36, p<0.05) and urethral funneling during Valsalva maneuvers (ρ=0.37, p<0.05) were significantly correlated to the severity of SUI whereas FUL and the PUCA were not. Bladder neck descent had the best area under the ROC curve (0.7685) for the diagnosis of SUI.
There was no significant correlation between the FUL or the PUCA and the severity of SUI. Bladder neck descent seemed to be the most reliable criteria for the diagnosis of SUI. Several factors may be responsible for a variation in the ultrasound measurements.
The French journal of urology. 2024 Dec 21 [Epub ahead of print]
P-A Mal, U Metzger, E Cornier, J Bloomfield, A-C Pizzoferrato, G Bader
Hôpital Pitié Salpêtrière, Service de chirurgie gynécologique, 83 Boulevard de l'Hôpital, 75013 Paris, France. Electronic address: ., Centres médicaux-chirurgicaux Ambroise Paré, Hartmann, Pierre Cherest, 26 Bd Victor Hugo, 92200 Neuilly-sur-Seine, France; Centre d'échographie de l'Odéon, 122 Boulevard Saint Germain, 75006 Paris, France., Centres médicaux-chirurgicaux Ambroise Paré, Hartmann, Pierre Cherest, 26 Bd Victor Hugo, 92200 Neuilly-sur-Seine, France., Centre hospitalier Universitaire de Poitiers, Gynécologie Obstétrique, 2 rue de la Milétrie, 86000 Poitiers, France.