International Urogynecology Journal

, Volume 20, Issue 2, pp 171–175

“The cough game”: are there characteristic urethrovesical movement patterns associated with stress incontinence?

  • Christina Lewicky-Gaupp
  • Jerry Blaivas
  • Amanda Clark
  • Edward J. McGuire
  • Gabriel Schaer
  • Julie Tumbarello
  • Ralf Tunn
  • John O. L. DeLancey
Original Article

Abstract

This study was carried out to determine whether five experts in female stress urinary incontinence (SUI) could discover a pattern of urethrovesical movement characteristic of SUI on dynamic perineal ultrasound. A secondary analysis of data from a case–control study was performed. Ultrasounds from 31 cases (daily SUI) and 42 controls (continent volunteers) of similar age and parity were analyzed. Perineal ultrasound was performed during a single cough. The five experts, blinded to continence status and urodynamics, classified each woman as stress continent or incontinent. Correct responses ranged from 45.7% to 65.8% (mean 57.4 ± 7.6). Sensitivity was 53.0 ± 8.8% and specificity 61.2 ± 12.4%. The positive predictive value was 48.8 ± 8.2% and negative predictive value was 65.0 ± 7.3%. Inter-rater reliability, evaluated by Cohen’s kappa statistic, averaged 0.47 [95% CI 0.40–0.50]. Experts could not identify a pattern of urethrovesical movement characteristic of SUI on ultrasound.

Keywords

Stress urinary incontinence Ultrasound Urethrovesical movement 

Abbreviations

SUI

stress urinary incontinence

MUCP

maximum urethral closure pressure

References

  1. 1.
    Bai SW, Kwon JY, Chung DJ, Park JH, Kim SK (2006) Differences in urodynamic study, perineal sonography and treatment outcome according to urethrovesical junction hypermobility in stress urinary incontinence. J Obstet Gynaecol Res 32:206–211PubMedCrossRefGoogle Scholar
  2. 2.
    Schaer GN, Perucchini D, Munz E, Peschers U, Koechli OR, Delancey JO (1999) Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet Gynecol 93:412–416PubMedCrossRefGoogle Scholar
  3. 3.
    Reddy AP, DeLancey JO, Zwica LM, Ashton-Miller JA (2001) On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet Gynecol 185:65–70PubMedCrossRefGoogle Scholar
  4. 4.
    DeLancey JOL, Trowbridge ER, Miller JM, Morgan DM, Guire K, Fenner DE (2008) Stress urinary incontinence: relative importance of urethral closure pressure. J Urology 179:2286–2290CrossRefGoogle Scholar
  5. 5.
    Hol M, van Bolhuis C, Vierhout ME (1995) Vaginal ultrasound studies of bladder neck mobility. Br J Obstet Gynaecol 102:47–53PubMedGoogle Scholar
  6. 6.
    Dalpiaz O, Curti P (2006) Role of perineal ultrasound in the evaluation of urinary stress incontinence and pelvic organ prolapse: a systematic review. Neurourol Urodyn 25:301–307PubMedCrossRefGoogle Scholar
  7. 7.
    Chen GD, Su TH, Lin LY (1997) Applicability of perineal sonography in anatomical evaluation of bladder neck in women with and without genuine stress incontinence. J Clin Ultrasound 25:189–194PubMedCrossRefGoogle Scholar
  8. 8.
    Sendag F, Vidinli H, Kazandi M, Itil IM, Askar N, Vidinli B et al (2003) Role of perineal sonography in the evaluation of patients with stress urinary incontinence. Aust N Z J Obstet Gynaecol 43:54–57PubMedCrossRefGoogle Scholar
  9. 9.
    Benson JT, Sumners JE, Pittman JS (1991) Definition of normal female pelvic floor anatomy using ultrasonographic techniques. J Clin Ultrasound 19:275–282PubMedCrossRefGoogle Scholar
  10. 10.
    Dietz HP, Clarke B, Herbison P (2002) Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct 13:289–293PubMedCrossRefGoogle Scholar
  11. 11.
    Minardi D, Piloni V, Amadi A, El Asmar Z, Milanese G, Muzzonigro G (2007) Correlation between urodynamics and perineal ultrasound in female patients with urinary incontinence. Neurourol Urodyn 26:176–184PubMedCrossRefGoogle Scholar
  12. 12.
    Dietz HP, Clarke B (2001) Translabial color Doppler urodynamics. Int Urogynecol J Pelvic Floor Dysfunct 12:304–307PubMedCrossRefGoogle Scholar
  13. 13.
    Martin JL, Williams KS, Sutton AJ, Abrams KR, Assassa RP (2006) Systematic review and meta-analysis of methods of diagnostic assessment for urinary incontinence. Neurourol Urodyn 25:674–684PubMedCrossRefGoogle Scholar
  14. 14.
    Bai SW, Kang JY, Rha KH, Lee MS, Kim JY, Park KH (2002) Relationship of urodynamic parameters and obesity in women with stress urinary incontinence. J Reprod Med 47:559–563PubMedGoogle Scholar
  15. 15.
    Cassado J, Pessarrodona A, Tulleuda R, Cabero L, Valls M, Quintana S et al (2006) Introital ultrasonography: a comparison of women with stress incontinence due to urethral hypermobility and continent women. BJU Int 98:822–828PubMedCrossRefGoogle Scholar
  16. 16.
    Borstad E, Rud T (1989) The risk of developing urinary stress-incontinence after vaginal repair in continent women. A clinical and urodynamic follow-up study. Acta Obstet Gynecol Scand 68:545–549PubMedCrossRefGoogle Scholar
  17. 17.
    DeLancey JOL, Miller JM, Kearney R, Howard D, Reddy P, Umek W et al (2007) Vaginal birth and de novo stress incontinence; relative contributions of urethral dysfunction and mobility. Obstet Gynecol 110:354–362PubMedGoogle Scholar
  18. 18.
    Karram MM, Bhatia NN (1988) The Q-tip test: standardization of the technique and its interpretation in women with urinary incontinence. Obstet Gynecol 71:807–811PubMedGoogle Scholar
  19. 19.
    Bai SW, Woo JW, Shin JS, Park JH, Kim SK, Park KH (2004) The predictive values of various parameters in the diagnosis of stress urinary incontinence. Yonsei Med J 45:287–292PubMedGoogle Scholar
  20. 20.
    Oliveira FR, Ramos JG, Martins-Costa S (2006) Translabial ultrasonography in the assessment of urethral diameter and intrinsic urethral sphincter deficiency. J Ultrasound Med 25:1153–1158PubMedGoogle Scholar
  21. 21.
    Tunn R, Goldammer K, Gauruder-Burmester A, Wildt B, Beyersdorff D (2005) Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound. Ultrasound Obstet Gynecol 26:287–292PubMedCrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2008

Authors and Affiliations

  • Christina Lewicky-Gaupp
    • 1
    • 7
  • Jerry Blaivas
    • 2
  • Amanda Clark
    • 3
  • Edward J. McGuire
    • 4
  • Gabriel Schaer
    • 5
  • Julie Tumbarello
    • 1
  • Ralf Tunn
    • 6
  • John O. L. DeLancey
    • 1
  1. 1.Division of Gynecology, Pelvic Floor Research Group, Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborUSA
  2. 2.Department of UrologyNew York-Presbyterian/Weill CornellNew YorkUSA
  3. 3.Division of Gynecology, Department of Obstetrics and GynecologyOregon Health Sciences UniversityPortlandUSA
  4. 4.Department of UrologyUniversity of Michigan Medical SchoolAnn ArborUSA
  5. 5.Department of Obstetrics and GynecologyKantonsspital AarauAarauSwitzerland
  6. 6.Department of Urogynecology, German Pelvic Floor CenterSt. Hedwig HospitalsBerlinGermany
  7. 7.Ann ArborUSA

Personalised recommendations