Transrectal Ultrasonography in Sitting Position in Stress Urinary Incontinence.

Kim,  Sung Woo; Yun,  Jung Kyong; Lee,  Jun Sik; Lee,  Il Gi; Kim,  Byung Young; Lee,  Jong Gil; Kim,  Hee Jin

Journal of Korean Society of Medical Ultrasound 1998;17(3): 215-219.

Sung Woo Kim, Jung Kyong Yun, Jun Sik Lee, Il Gi Lee, Byung Young Kim, Jong Gil Lee, Hee Jin Kim

Department of Diagnostic Radiology, Fatima Hospital Taegu, Korea.

Published online: January 1, 2001.

ABSTRACT

PURPOSE: To evaluate the usefulness of transrectal ultrasonography in sitting position in the assessment of urinary incontinence in female patients. MATERIALS & METHODS: Transrectal ultrasonography was performed to twenty two patients with stress urinary incontinence(mean age 50.7) and ten patients without urinary incontinence(mean age 42.5). Using a sagittal section of the anterior pelvis, the posterior urethro-vesical angle(PUVA), the pubo-urethral distance and the beaking of internal urethral orifice were measured at rest and during stress(Ualsalva's maneuver state). The student T-test and Fisher's exact test were used for statistial analysis. RESULTS: Mean PUVA of the control group was 128.8 degrees(+/- 11.2 standard deviation) at rest and 145.0 degrees(+/- 9.2) during stress. In the patients, the corresponding angles were 142.0 degrees(+/- 7.8) and 164.9 degrees(+/- 7.1) respectively. The PUVA was increased 16.2 degrees(+/- 11.6) in the control group and 22.9 degrees(+/- 9.6) in the patients(p <0.05). In the controls, the pubo-urethral distance was 14.3mm(+/- 2.8) at rest and 16.5mm(+/- 1.6) during stress, while in the patients this distance was 18.1mm(+/- 5.0) and 22.7mm(+/- 5.7). The pubo-urethral distance was increased 2.2mm(+/- 2.1) in control group and 4.6mm(+/- 3.8) in the patients(p>0.05). However there was no statistically significant difference in the PUVA and the pubo-urethral distance between patients with mild incontinence(Grade I) and moderate incontinence(Grade II)(p>0.05). The beaking og internal urethral orifice was absent in any of control group, but was present in all patients(p<0.05). The diagnostic criteria of urinary stress incontinence were >151.5 degrees of PUVA during stress(sensitivity 95.5%, specificity 80%), <17.6mm of pubo-urethral distance during stress(sensitivity 86.4%, specificity 60%), and presence of the beaking of internal urethral orifice(sensitivity 100%, specificity 100%). CONCLUSION: Transrectal ultrasonography in sitting position may be useful for assessment of urinary incontinence.

Keywords: Urine, incontinence; Bladder, US; Urethra, US