Ultrasound of the female urethra
File(s)
Author(s)
Karmarkar, Roopali
Type
Thesis
Abstract
Background: Many theories have been put forward to explain the urinary continence mechanism. Though they seem logical, there is insufficient evidence to support them. Ultrasound has been implemented by researchers to investigate these theories. There is considerable difference in their methodologies and their conclusions. Most of the research on urethral ultrasound is related to stress incontinence; there is a lack of studies on other urodynamic diagnoses.
Aim: To compare the measurements of the female urethra by transperineal ultrasound in women with different urodynamic diagnoses and different vaginal parities.
Methodology: 150 women had urodynamic studies and 2 and 3 dimensional transperineal ultrasound. They were divided into 4 groups according to their urodynamic diagnosis as nondiagnostic urodynamics(NU), pure detrusor overactivity(PureDO), pure urodynamic stress incontinence(PureUSI) and mixed urinary incontinence(MUI) and also according to their vaginal parity. New methods of measuring urethral position, bladder neck position and urethral dimension are developed and used for measurement. Multiple regression analysis was performed using a model of urethral sphincter volume(USV), bladder neck position(BNP) and pubourethral distance.
Key findings: USV was smallest in PureUSI and largest in PureDO groups. BNP at rest was lower in all incontinent groups than NU. MUI group had normal sphincter size but lower BNP. There was no difference in the bladder neck mobility or urethral mobility. Urethral compression was evident in all groups. The statistical model correctly classified 68.2% women with urodynamic stress incontinence and 69.8% women with detrusor overactivity. The urethral sphincter was smaller in women who had a vaginal delivery but there was no difference in the sphincter size of primiparous and multiparous women.
Conclusion: Urethral sphincter volume and bladder neck position are the most differentiating factors for the types of urinary incontinence. Subsequent vaginal delivery in primiparous women may not increase their risk of having urinary incontinence.
Aim: To compare the measurements of the female urethra by transperineal ultrasound in women with different urodynamic diagnoses and different vaginal parities.
Methodology: 150 women had urodynamic studies and 2 and 3 dimensional transperineal ultrasound. They were divided into 4 groups according to their urodynamic diagnosis as nondiagnostic urodynamics(NU), pure detrusor overactivity(PureDO), pure urodynamic stress incontinence(PureUSI) and mixed urinary incontinence(MUI) and also according to their vaginal parity. New methods of measuring urethral position, bladder neck position and urethral dimension are developed and used for measurement. Multiple regression analysis was performed using a model of urethral sphincter volume(USV), bladder neck position(BNP) and pubourethral distance.
Key findings: USV was smallest in PureUSI and largest in PureDO groups. BNP at rest was lower in all incontinent groups than NU. MUI group had normal sphincter size but lower BNP. There was no difference in the bladder neck mobility or urethral mobility. Urethral compression was evident in all groups. The statistical model correctly classified 68.2% women with urodynamic stress incontinence and 69.8% women with detrusor overactivity. The urethral sphincter was smaller in women who had a vaginal delivery but there was no difference in the sphincter size of primiparous and multiparous women.
Conclusion: Urethral sphincter volume and bladder neck position are the most differentiating factors for the types of urinary incontinence. Subsequent vaginal delivery in primiparous women may not increase their risk of having urinary incontinence.
Version
Open Access
Date Issued
2018-03
Date Awarded
2019-02
Copyright Statement
Creative Commons Attribution NonCommercial NoDerivatives Licence
Advisor
Khullar, Vikram
Regan, Lesley
Publisher Department
Department of Surgery & Cancer
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Medicine (Research) MD (Res)