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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

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