Evaluation of urinary stress incontinence by transperineal ultrasonography

2. ABSTRACTEVALUATION OF URINARY STRESS INCONTINENCE BYTRANSPERINEAL ULTRASONOGRAPHYOur aim was to investigate the role of perineal ultrasonographic imaging inthe evaluation of stress incontinence.The study included between March 2004 and July 2004, 60 women admittedto the Obstetric and Gynecology and Urology Departments of the Medical Faculty,Fırat University. 42 women with urinary stress incontinence history and with positiveMarshall-Marchetti and Bonney tests constituted the incontinent group (study group),and 18 women with no urinary incontinence history the control group(control group).Of these 42 incontinent women were 20 premenopausal stage, 22postmenopausal stage. Of these 22 postmenapousal women were received hormonereplacement theraphy (HRT) (n:10) and not received HRT (n:12).Real time and power Doppler Ultrasonography examinations were performedhave been used perineally during both resting and straining. In 60 women the byusing the posterior edge of the symphysis pubis as reference point, distance Dy andDx, PUVA, bladder neck diameter, urethral diameter were measured during supin-erect position and resting-straining maneuver. In power Doppler Ultrasonographyexamination, RI, PI, V max and V min were measured in doppler waveformsobtained from periurethral arteries in the nearest region to bladder neck.When study and control groups compared, cephalocaudal distance (desensusdiameter) was longer in patients with stress urinary incontinence (SUI) on straining(P<0.05 and P<0.01). The position of bladder neck at rest was higher in the supineposition (P<0.001) and it descended further with a valsalva maneuver (P<0.001).Urethral funneling on valsalva was more likely in the erect position, as was urineleakage documented by power Doppler imaging. Urine loss as documented by powerDoppler in 3 women urine loss only evident in erect position. The PI wassignificantly higher in the postmenopausal than in the premenopausal women(P<0.05). HRT increases the blood flow around the bladder neck and periurethrallocation in postmenapousal women.2