open access

Vol 89, No 2 (2018)
Research paper
Published online: 2018-03-07
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Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients

Edyta Wlaźlak, Tomasz Kluz, Grzegorz Surkont, Jacek Kociszewski
DOI: 10.5603/GP.a2018.0010
·
Pubmed: 29512808
·
Ginekol Pol 2018;89(2):55-61.

open access

Vol 89, No 2 (2018)
ORIGINAL PAPERS Gynecology
Published online: 2018-03-07

Abstract

Objectives: There are different diagnostic methods used in women with urinary incontinence symptoms such as: medical history, voiding diary, cough test, pad test, urodynamic testing. None of them is optimal. The aim of this study is to analyze the correlation between urethral funneling visualized during pelvic floor sonography and symptoms of stress urinary incontinence.

Material and methods: We have performed a retrospective analysis of 657 complete datasets of patients who attended our urogynecological clinic for diagnostics. Women with wet overactive bladder were excluded from the analysis. Tests used in our clinic included: standardized interview and questionnaire, clinical exam, cough test. Pelvic floor sonography with a transvaginal probe in women with filled bladder was performed to assess the urethral length and the urethral funneling during maximal Valsalva maneuver.

Results: In all patients with clinical SUI symptoms and with a positive cough test the urethral funneling length during Valsalva maneuver was > 50% of urethral length (long urethral funneling). In 83.7% of women without SUI the urethral funneling was absent. In the remaining 16.3% funneling was visible but its relative length was less than 50% of urethral length and urine flow was not observed (short urethral funneling).

Conclusions: Long urethral funneling (> 50% of urethral length) seems to be a characteristic sign for SUI in women. The presence of urethral funneling shorter than 50% of urethral length (short urethral funneling) is not a SUI symptom — it is probably a sign of asymptomatic funneling of bladder neck.

Abstract

Objectives: There are different diagnostic methods used in women with urinary incontinence symptoms such as: medical history, voiding diary, cough test, pad test, urodynamic testing. None of them is optimal. The aim of this study is to analyze the correlation between urethral funneling visualized during pelvic floor sonography and symptoms of stress urinary incontinence.

Material and methods: We have performed a retrospective analysis of 657 complete datasets of patients who attended our urogynecological clinic for diagnostics. Women with wet overactive bladder were excluded from the analysis. Tests used in our clinic included: standardized interview and questionnaire, clinical exam, cough test. Pelvic floor sonography with a transvaginal probe in women with filled bladder was performed to assess the urethral length and the urethral funneling during maximal Valsalva maneuver.

Results: In all patients with clinical SUI symptoms and with a positive cough test the urethral funneling length during Valsalva maneuver was > 50% of urethral length (long urethral funneling). In 83.7% of women without SUI the urethral funneling was absent. In the remaining 16.3% funneling was visible but its relative length was less than 50% of urethral length and urine flow was not observed (short urethral funneling).

Conclusions: Long urethral funneling (> 50% of urethral length) seems to be a characteristic sign for SUI in women. The presence of urethral funneling shorter than 50% of urethral length (short urethral funneling) is not a SUI symptom — it is probably a sign of asymptomatic funneling of bladder neck.

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Keywords

ultrasound, female, pelvic floor sonography, transvaginal probe, urethral funneling, stress urinary incontinence

About this article
Title

Urethral funneling visualized during pelvic floor sonography — analysis of occurrence among urogynecological patients

Journal

Ginekologia Polska

Issue

Vol 89, No 2 (2018)

Article type

Research paper

Pages

55-61

Published online

2018-03-07

DOI

10.5603/GP.a2018.0010

Pubmed

29512808

Bibliographic record

Ginekol Pol 2018;89(2):55-61.

Keywords

ultrasound
female
pelvic floor sonography
transvaginal probe
urethral funneling
stress urinary incontinence

Authors

Edyta Wlaźlak
Tomasz Kluz
Grzegorz Surkont
Jacek Kociszewski

References (35)
  1. Garely AD, Noor N. Diagnosis and surgical treatment of stress urinary incontinence. Obstet Gynecol. 2014; 124(5): 1011–1027.
  2. Holroyd-Leduc JM, Tannenbaum C, Thorpe KE, et al. What type of urinary incontinence does this woman have? JAMA. 2008; 299(12): 1446–1456.
  3. Surkont G, Wlaźlak E, Petri E, et al. Standardized modified colposuspension--mid-term results of prospective studies in one centre. Ann Agric Environ Med. 2015; 22(2): 293–296.
  4. Rohr G, Christensen K, Ulstrup K, et al. Reproducibility and validity of simple questions to identify urinary incontinence in elderly women. Acta Obstet Gynecol Scand. 2004; 83(10): 969–972.
  5. Surkont G, Wlaźlak E, Suzin J. Long-term risk of complications after mid-urethral sling IVS implantation. Ann Agric Environ Med. 2015; 22(1): 163–166.
  6. Stangel-Wojcikiewicz K, Piwowar M, Jach R, et al. Quality of life assessment in female patients 2 and 4 years after muscle-derived cell transplants for stress urinary incontinence treatment. Ginekol Pol. 2016; 87(3): 183–189.
  7. Staskin D, Kelleher C, Avery K, Cardozo L, Khoury S, Wein A. et al.. Initial Assessment of Urinary and Faecal Incontinence in Adult Male and Female Patients. In: Abrams P, Cardozo L, Khoury S, Wein A. ed. Incontinence. Health Publication Ltd 2009: 331–412.
  8. Wlaźlak E, Surkont G, Shek KaL, et al. Can we predict urinary stress incontinence by using demographic, clinical, imaging and urodynamic data? Eur J Obstet Gynecol Reprod Biol. 2015; 193: 114–117.
  9. Bright E, Drake MJ, Abrams P. Urinary diaries: evidence for the development and validation of diary content, format, and duration. Neurourol Urodyn. 2011; 30(3): 348–352.
  10. Tannenbaum C, Corcos J. Outcomes in urinary incontinence: reconciling clinical relevance with scientific rigour. Eur Urol. 2008; 53(6): 1151–1161.
  11. Versi E. The significance of an open bladder neck in women. Br J Urol. 1991; 68(1): 42–43.
  12. Ghoniem GM, Elgamasy AN, Elsergany R, et al. Grades of intrinsic sphincteric deficiency (ISD) associated with female stress urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2002; 13(2): 99–105; discussion 105.
  13. Harms L, Emons G, Bader W, et al. Funneling before and after anti-incontinence surgery--a prognostic indicator? Part 2: tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct. 2007; 18(3): 289–294.
  14. Versi E, Cardozo L, Studd J, et al. Distal urethral compensatory mechanisms in women with an incompetent bladder neck who remain continent, and the effect of the menopause. Neurourol Urodyn. 1990; 9(6): 579–590.
  15. Schaer GN, Perucchini D, Munz E, et al. Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet Gynecol. 1999; 93(3): 412–416.
  16. Tunn R, Goldammer K, Gauruder-Burmester A, et al. Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound. Ultrasound Obstet Gynecol. 2005; 26(3): 287–292.
  17. Schaer GN, Koechli OR, Schuessler B, et al. Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium. Obstet Gynecol. 1995; 86(6): 950–954.
  18. Bergström BoS. Curative mechanisms of two tension-free vaginal tape positions. Theoretical comments based on the urethral hanging theory of female stress urinary incontinence. Neurourol Urodyn. 2017; 36(8): 2181–2183.
  19. Wlazlak E, Viereck V, Surkont G, [et al.]. The significance of urethral funneling and urine flow (PF-ultrasound) in evaluating stress urinary incontinence [Abstract]. Poster ICS 2014; Rio de Janeiro. www.ics.org/Abstracts/Publish/218/000234.pdf (20th–24th October 2014).
  20. Kluz T, Wlaźlak E, Surkont G. Transvaginal six-arm mesh OPUR in women with apical pelvic organ prolapse - analysis of short-term results, pelvic floor ultrasound evaluation. Ginekol Pol. 2017; 88(6): 302–306.
  21. Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound. Ultrasound Obstet Gynecol. 2005; 25(6): 580–585.
  22. Dietz HP, Bernardo MJ, Kirby A, et al. Minimal criteria for the diagnosis of avulsion of the puborectalis muscle by tomographic ultrasound. Int Urogynecol J. 2011; 22(6): 699–704.
  23. Tunn R, Albrich S, Beilecke K, et al. Interdisciplinary S2k Guideline: Sonography in Urogynecology: Short Version - AWMF Registry Number: 015/055. Geburtshilfe Frauenheilkd. 2014; 74(12): 1093–1098.
  24. Kociszewski J, Rautenberg O, Kuszka A, et al. Can we place tension-free vaginal tape where it should be? The one-third rule. Ultrasound Obstet Gynecol. 2012; 39(2): 210–214.
  25. Viereck V, Kuszka A, Rautenberg O, et al. Do different vaginal tapes need different suburethral incisions? The one-half rule. Neurourol Urodyn. 2015; 34(8): 741–746.
  26. Wlaźlak E, Viereck V, Kociszewski J, et al. Role of intrinsic sphincter deficiency with and without urethral hypomobility on the outcome of tape insertion. Neurourol Urodyn. 2017; 36(7): 1910–1916.
  27. Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996; 175(1): 10–17.
  28. Lemos N, Korte JE, Iskander M, et al. Center-by-center results of a multicenter prospective trial to determine the inter-observer correlation of the simplified POP-Q in describing pelvic organ prolapse. Int Urogynecol J. 2012; 23(5): 579–584.
  29. Dietz HP. Pelvic floor ultrasound in incontinence: what's in it for the surgeon? Int Urogynecol J. 2011; 22(9): 1085–1097.
  30. Goldstein SR. Postmenopausal endometrial fluid collections revisited: look at the doughnut rather than the whole. Obstet Gynecol. 1994; 83(5 Pt 1): 738–740.
  31. Goldstein SR. Use of ultrasonohysterography for triage of perimenopausal patients with unexplained uterine bleeding. Am J Obstet Gynecol. 1994; 170(2): 565–570.
  32. Nicolaides KH, Syngelaki A, Ashoor G, et al. Noninvasive prenatal testing for fetal trisomies in a routinely screened first-trimester population. Am J Obstet Gynecol. 2012; 207(5): 374.e1–374.e6.
  33. Santiago AC, Quiroz LH, Shobeiri SA. Decreased Urethral Volume Is Comparable to Funneling as a Predictor of Intrinsic Sphincter Deficiency. Female Pelvic Med Reconstr Surg. 2017; 23(5): 336–342.
  34. Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990; 153: 7–31.
  35. Ulmsten U. The basic understanding and clinical results of tension-free vaginal tape for stress urinary incontinence. Urologe A. 2001; 40(4): 269–273.

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