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Published: 2023-10-30
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DOI: https://doi.org/10.52852/tcncyh.v170i9.1862
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Vol. 170 No. 9 (2023)
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Âu, H. Đình, Dung, V. T., & Hiền, M. M. (2023). 3. Evaluation of female urethral parameterson dynamic pelvic floor magnetic resonance imaging in patients with stress urinary incontinence. Journal of Medical Research, 170(9), 17-26. https://doi.org/10.52852/tcncyh.v170i9.1862

3. Evaluation of female urethral parameterson dynamic pelvic floor magnetic resonance imaging in patients with stress urinary incontinence

Hoang Dinh Au, Vu Thi Dung, Ma Mai Hien

Main Article Content

Abstract

The study compared the female urethral parameters on dynamic pelvic floor magnetic resonance imaging between the patient group (22 patients) with the group without SUI disorders (21 patients) to look for associated anatomical abnormalities. In both rest and evacuation phases, there was no statistically significant difference (p > 0.05) between the 2 groups in terms of length, transverse diameter, urethral outer layer thickness, urethral angle, bladder neck - pubococcygeal angle, position of the bladder neck with the pubococcygeal line. In contrast, there was a statistically significant difference between the 2 groups in terms of volume, anteroposterior diameter, inner urethral thickness (p < 0.05) and posterior urethro-vesical angle (p < 0.001). For the diagnosis of stress urinary incontinence, at rest and evacuation phases, the posterior urethra-vesical angle had AUC, sensitivity and specificity of 0.9 and 0.98; 0.86 and 0.91; 0.86 and 0.95 respectively (with thresholds of 133.50 at rest and 153.50 at evacuation phase).


Material and method: This prospective study was carried out on 43 female patients, including 22 patients with SUI (disease group) and 21 patients without SUI (control group), all underwent the dynamic pelvic floor MRI. The length, the volume, the transverse and anteroposterior diameter, the outer and inner layer thickness of the urethra were measured on static T2W pulse sequences in axial and sagittal plane. Urethral angle (UA), posterior urethro-vesical angle (PUVA), bladder neck – pubo-coccygeal angle (BNPCA), the position of bladder neck (BN) and cervix relative to the pubococcygeal line (PCL) were measured on dynamic (Cine) pulse sequences at rest and evacuation phases in sagittal plane. These parameters were compared between two groups to find the anatomical abnormality causing SUI. calculated the diagnostic performance, the sensitivity and specificity of these parameters in the diagnosis of SUI.


Results: The mean age of the patients was 57.3±13.8 y.o (disease group: 53.9±12.6 y.o, control group: 60.8±14.4 y.o), the mean number of childbirths was 2.2±0.65, the vaginal delivery accounted for 73% in each group. There was no statistically significant difference (p>0,05) between the two groups in terms of length, the transverse diameter, the outer layer thickness of the urethra, the UA, the BNPCA, position of BN relative to PCL in both resting and evacuation phases. In contrast, there was a statistically significant difference between the 2 groups in the volume (p=0,014), the anteroposterior diameter (p=0,01), the inner layer thickness of the urethra (p=0,04), and the posterior urethro-vesical angle (p<0,001) at both rest and evacuation phases and the cervix position at evacuation phase (p=0,001). The AUC of the PUVA for the SUI diagnosis was 0,9 at rest and 0.98 at evacuation phases. For the threshold 133,50 at rest phase and 153,50 at evacuation phase, the sensibility and specificity of PUVA were 0,86 and 0,86 at rest phase, and 0,91 and 0,95 at evacuation phase, respectively.


Conclusion: Our study shows that the high PUVA was the most anatomical abnormality associated with SUI, with high sensitivity and specificity for the diagnosis of SUI.

Article Details

Keywords

Dynamic pelvic floor MRI, Stress Urinary Incontinence, Posterior urethra-vesical angle

References

1. Masson E. The standardisation of terminology in lower urinary tract function: report from the standardisation sub-committee of the International Continence Society. EM-Consulte. Accessed September 15, 2022.
2. Nygaard IE, Heit M. Stress Urinary Incontinence: Obstet Gynecol. 2004; 104(3): 607-620.
3. DeLancey, J.O. Structural support of the urethra as it relates to stress urinary incontinence: The hammock hypothesis. Am. J. Obstet. Gynecol. 1994, 170, 1713–1720.
4. Kobra Falah-Hassani, Joanna Reeves et al. The pathophysiology of stress urinary incontinence: a systematic review and meta-analysis. International Urogynecology Journal. 2021; 32:501-552.
5. Nguyễn Thị Tân Sinh (2006). Nghiên cứu thực trạng són tiểu và một số yếu tố liên quan ở nữ nhân viên bệnh viện Bạch Mai. Trường Đại Học Y Hà Nội, Hà Nội.
6. Kim JK, Kim YJ, Choo MS, Cho KS. The urethra and its supporting structures in women with stress urinary incontinence: MR imaging using an endovaginal coil. AJR Am J Roentgenol. 2003; 180(4): 1037-44. https://doi.org/10.2214/ajr.180.4. 1801037.
7. Tasali N, Cubuk R, sinanoğlu O, Şahin K, Saydam B. MRI in Stress Urinary Incontinence Endovaginal MRI With an Intracavitary Coil and Dynamic Pelvic MRI. Urol J. 2012; 9:397-404.
8. Li M, Wang B, Liu X, Qiao P, Jiao W, Jiang T. MR defecography in the assessment of anatomic and functional abnormalities in stress urinary incontinence before and after pelvic reconstruction. Eur J Radiol. 2020; 126:108935. https://doi.org/10.1016/j.ejrad. 2020.108935.
9. Li N, Cui C, Cheng Y, Wu Y, Yin J, Shen W. Association between Magnetic Resonance Imaging Findings of the Pelvic Floor and de novo Stress Urinary Incontinence after Vaginal Delivery. Korean J Radiol. 2018; 19(4):715.
10. Ansquer Y, Fernandez P et al. MRI urethrovesical junction mobility is associated with global pelvic floor laxity in female stress incontinence. Acta Obstet Gynecol Scand. 2007; 86(10):1243-1250.
11. Lukanovic A, Patrelli TS. Validation of ultrasound scan in the diagnosis of female stress urinary incontinence. Clin Exp Obstet Gynecol. 2011; 38(4): 373-8.
12. Macura KJ, Thompson RE, Bluemke DA, Genadry R. Magnetic resonance imaging in assessment of stress urinary incontinence in women: parameters differentiating urethral hypermobility and intrinsic sphincter deficiency. World J Radiol. 2015; 7(11): 394-404.
13. João Cunha Salvador, Mónica Portela Coutinho et al. Dynamic magnetic resonance imaging of the female pelvic floor-a pictorial review. Insights Imaging. 2019 Jan 28; 10(1):4.
14. Zidan S, Amin M, Hemat E, Samaha I. Female urinary incontinence: spectrum of findings at pelvic mri and urodynamics. Zagazig Univ Med J. 2016;22:1-9.
15. Li YQ, Geng J, Tan C, Tang J, Yang X. Diagnosis and classification of female stress urinary incontinence by transperineal two- dimensional ultrasound. Technol Health Care. 2017;25(5):859– 66. https://doi.org/10.3233/THC-160786.
16. Rinne KM, Kainulainen S, Aukee S, Heinonen S, Nilsson CG. Dynamic magnetic resonance imaging of the behavior of the mid- urethra in healthy and stress incontinent women. Acta Obstet Gynecol Scand. 2010;89(3):373–9. https://doi.org/10.3109/ 00016340903555982
17. Tarhan S, Gümüş B, Temeltaş G, Ovali GY, Serter S, Göktan C. The comparison of MRI findings with severity score of incontinence after pubovaginal sling surgery. Turk J Med Sci. Published online January 1, 2010.