Objective To compare urodynamic studies (UDS) and perineal sonography for assessing mixed urinary incontinence
(MUI) in women.Methods A total of 118 adult females with MUI and 30 controls were enrolled from September, 2010 to December,2017. Their baseline clinical characteristics were recorded. The MUI patients were divided into stress-predominant (S-MUI, n=51), urge- predominant (U-MUI, n=34) and equal predominance (E-MUI, n=33) according to
King's Health Questionnaire. Both UDS and perineal sonography were performed in all the subjects. Tolerability
of the two methods was compared. Results For sonography parameters, compared with the controls, S-MUI patients had greater dynamic posterior urethral angle, dynamic angle of urethral inclination, dynamic pubo- urethral distance and descent of bladder neck (P< 0.001), U-MUI patients had greater detrusor thickness (P<0.05), and E-MUI patients had greater descent of bladder neck (P<0.05). For UDS parameters, compared with the controls, S-MUI patients had lower Pure.clos.max
and functional urethral length; U-MUI patients had lower Qmax, smaller bladder volume, higher Pdet.open, higher
Pdet.Qmax and higher incidence of detrusor overactivity; and E-MUI patients had higher Pdet.Qmax and lower
Pure.clos.max (P<0.05). All UDS and sonography parameters differed significantly between S- MUI and
U-MUI patients. The descent of the bladder neck, dynamic angle of urethral inclination, and dynamic pubourethral
distance were negatively correlated with detrusor pressure at maximal flow and functional urethral length,
while detrusor wall thickness was positively correlated with detrusor pressure at maximal flow and functional
urethral length. Perineal ultrasound was better tolerated than UDS in 82.3% patients.Conclusion Perineal sonography parameters show good correlation with UDS parameters. Ultrasonography is better tolerated than UDS and provides additional morphologic data. Perineal sonography could facilitate to diagnose U-MUI.
HU Yang
,
LOU Ye-lin
,
WU Hai-xiao
,
WU Han
,
YANG Qing
,
MA Min
. Comparison of Urodynamics and Perineal Ultrasound for Diagnosis of Mixed Urinary Incontinence inWomen[J]. Chinese Journal of Rehabilitation Theory and Practice, 2018
, 24(6)
: 713
-719
.
DOI: 10.3969/j.issn.1006-9771.2018.06.017
[1] Brucker BM. Expectations of stress urinary incontinence surgery
in patients with mixed urinary incontinence [J]. Rev Urol,
2015, 17(1): 14-19.
[2] Solberg M, Alraek T, Mdala I, et al. A pilot study on the use of
acupuncture or pelvic floor muscle training for mixed urinary
incontinence [J]. Acupunct Med, 2016, 34(1): 7-13.
[3] 李琳,朱兰,郎景和,等. 中国成年女性混合性尿失禁的流行病
学调查[J]. 中华医学杂志, 2010, 90(21): 1487-1490.
[4] Minassian VA, Devore E, Hagan K, et al. Severity of urinary incontinence
and effect on quality of life in women by incontinence
type [J]. Obstet Gynecol, 2013, 121(5): 1083-1090.
[5] Abraham N, Vasavada S. Urgency after a sling: review of the
management [J]. Curr Urol Rep, 2014, 15(4): 400.
[6] 文建国,朱文,杨黎,等. 动态尿动力学与常规尿动力学检查评
估女性压力性尿失禁的对比研究[J]. 中华泌尿外科杂志,2013, 34(2): 116-119.
[7] Abrams P, Cardozo L, Fall M, et al. The standardisation of terminology
of lower urinary tract function: report from the Standardisation
Sub-committee of the International Continence Society
[J]. Neurourol Urodyn, 2002, 21(2): 167-178.
[8] Kelleher CJ, Cardozo LD, Khullar V, et al. A new questionnaire
to assess the quality of life of urinary incontinent women [J].Br J Obstet Gynaecol, 1997, 104(12): 1374-1379.
[9] Schafer W, Abrams P, Liao L, et al. Good urodynamic practices:uroflowmetry, filling cystometry, and pressure- flow studies
[J]. Neurourol Urodyn, 2002, 21(3): 261-274.
[10] Bump RC, Norton PA, Zinner NR, et al. Mixed urinary incontinence
symptoms: urodynamic findings, incontinence severity,
and treatment response [J]. Obstet Gynecol, 2003, 102(1):76-83.
[11] Jung SY, Fraser MO, Ozawa H, et al. Urethral afferent nerve
activity affects the micturition reflex; implication for the relationship
between stress incontinence and detrusor instability
[J]. J Urol, 1999, 162(1): 204-212.
[12] Shah AP, Mevcha A, Wilby D, et al. Continence and micturition:
an anatomical basis [J]. Clin Anat, 2014, 27(8):1275-1283.
[13] Digesu GA, Salvatore S, Fernando R, et al. Mixed urinary
symptoms: what are the urodynamic findings? [J]. Neurourol
Urodyn, 2008, 27(5): 372-375.
[14] Katsumi HK, Rutman MP. Can we predict if overactive bladder
symptoms will resolve after sling surgery in women with
mixed urinary incontinence? [J]. Curr Urol Rep, 2010, 11(5):328-337.
[15] Loran OB, Seregin AV, Dovlatov ZA. Assessments of
long- term results of different types of sling procedures for
stress urinary incontinence in women [J]. Urologiia, 2016(1):40-45.
[16] Paick JS, Oh SJ, Kim SW, et al. Tension-free vaginal tape, suprapubic
arc sling, and transobturator tape in the treatment of
mixed urinary incontinence in women [J]. Int Urogynecol J Pelvic
Floor Dysfunct, 2008, 19(1): 123-129.
[17] Gamble TL, Botros SM, Beaumont JL, et al. Predictors of persistent
detrusor overactivity after transvaginal sling procedures
[J]. Am J Obstet Gynecol, 2008, 199(6): 691-696.
[18] Umek WH, Obermair A, Stutterecker D, et al. Three-dimensional
ultrasound of the female urethra: comparing transvaginal
and transrectal scanning [J]. Ultrasound Obstet Gynecol, 2001,
17(5): 425-430.
[19] Huang YL, Chen HY. Computer-aided diagnosis of urodynamic
stress incontinence with vector-based perineal ultrasound using
neural networks [J]. Ultrasound Obstet Gynecol, 2007, 30
(7): 1002-1006.
[20] Li YQ, Geng J, Tan C, et al. Diagnosis and classification of female
stress urinary incontinence by transperineal two- dimensional
ultrasound [J]. Technol Health Care, 2017, 25(5):859-866.
[21] Sendag F, Vidinli H, Kazandi M, et al. Role of perineal sonography
in the evaluation of patients with stress urinary incontinence
[J]. Aust N Z J Obstet Gynaecol, 2003, 43(1): 54-57.
[22] Costantini S, Nadalini C, Esposito F, et al. Perineal ultrasound
evaluation of the urethrovesical junction angle and urethral
mobility in nulliparous women and women following vaginal
delivery [J]. Int Urogynecol J Pelvic Floor Dysfunct, 2005, 16
(6): 455-459.
[23] van Veelen GA, Schweitzer KJ, van der Vaart CH. Ultrasound
imaging of the pelvic floor: changes in anatomy during and after
first pregnancy [J]. Ultrasound Obstet Gynecol, 2014, 44
(4): 476-480.
[24] Torella M, De Franciscis P, Russo C, et al. Stress urinary incontinence:
usefulness of perineal ultrasound [J]. Radiol Med,
2014, 119(3): 189-194.
[25] Solomon E, Yasmin H, Duffy M, et al. Developing and validating
a new nomogram for diagnosing bladder outlet obstruction
in women [J]. Neurourol Urodyn, 2018, 37(1): 368-378.
[26] Carr LK, Webster GD. Bladder outlet obstruction in women
[J]. Urol Clin North Am, 1996, 23(3): 385-391.
