International Urogynecology Journal

, Volume 23, Issue 9, pp 1239–1244 | Cite as

Does bladder wall thickness decrease when obstruction is resolved?

  • Annette KuhnEmail author
  • Sonja Brandner
  • Peter Kuhn
  • Dudley Robinson
  • Luigi Raio
Original Article


Introduction and hypothesis

The aim of the current study was to determine if sonographic bladder wall thickness diminishes after symptomatic obstruction is resolved in female patients after stress incontinence surgery.


Between December 2008 and December 2010, 62 female patients with symptomatic bladder outlet obstruction, as defined by Blaivas, who had undergone prior surgery for urinary stress incontinence were included in the study. The patients’ history was taken and symptoms were noted. Patients underwent gynaecological examination, and multichannel urodynamic assessment was performed. Vaginal sonographic assessment of the bladder wall thickness (BWT) was performed before and after urethrolysis.


62 patients were included in this study, 55 of whom had undergone suburethral sling insertion and seven had Burch colposuspension. Postoperatively, BWT decreased significantly from 9.1 mm ± 2.1 to 7.6 mm ± 2.2 (p < 0.0001). In seven patients, obstruction was still unresolved postoperatively; of these, two had undergone a retropubic sling insertion and two had a Burch colposuspension. An ROC curve analysis showed a significant positive association between residual urine and persistent obstruction before surgery (AUC 0.76, 95%CI 0.58–0.94; p < 0.05).


If obstruction is resolved, bladder wall thickness decreases. Preoperatively elevated residual urine may increase the risk of persistent obstruction after urethrolysis.


Sonographic bladder wall thickness Urodynamic obstruction Urethrolysis Surgery for urodynamic stress incontinence 


Conflicts of interest


Ethical approval

Ethical approval was given by the Kantonale Ethikkommission Bern (KEK), President: Prof. Niklaus Tüller. Registration number is E 01-04-10 and this study belongs to the quality control rules of our institution.


  1. 1.
    Jarvis GH, Hall S, Stamp S, Millar DR, Johnson A (1980) An assessment of urodynamic examination in incontinent women. Br J Obstet Gynaecol 87:893–896PubMedCrossRefGoogle Scholar
  2. 2.
    Bates CP, Whiteside CG, Turner-Warwick R (1970) Synchronous cine-pressure-flow-cystourethrography with special reference to stress and urge incontinence. Br J Urol 42:714–723PubMedCrossRefGoogle Scholar
  3. 3.
    Glazener CM, Lapitan MC (2002) Urodynamic investigations for management of urinary incontinence in adults. Cochrane Database Syst Rev 3:CD 003195Google Scholar
  4. 4.
    Gorton E, Stanton SL (2000) Ambulatory urodynamics: do they help clinical management? BJOG 107:316–319PubMedCrossRefGoogle Scholar
  5. 5.
    Robinson D, Anders L, Cardozo L, Bidmenad J, Toozs-Hobson P, Khullar V (2002) Can ultrasound replace ambulatory urodynamics when investigating women with irritative urinary symptoms? BJOG 109:145–148PubMedCrossRefGoogle Scholar
  6. 6.
    Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U, van Kerrebroek P, Victor A, Wein A (2002) The standardisation of terminology of lower urinary tract function: report from the standardisation sub-committee of the international continence society. Neurourol Urodyn 21:167–178PubMedCrossRefGoogle Scholar
  7. 7.
    Khullar V, Salvatore S, Cardozo LD, Kelleher C, Bourne TH (1994) A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound. Ultrasound Obstet Gynecol 4:220–223PubMedCrossRefGoogle Scholar
  8. 8.
    Salvatore S, Khullar V, Anders K, Cardozo LD (1998) Reducing artefacts in ambulatory urodynamics. BrJ Urol 81:211–214CrossRefGoogle Scholar
  9. 9.
    Oelke M, Mamoulakis C, Ubbink DT, de la Rosette JJ, Wijkstra H (2009) Manual versus automatic bladder wall thickness measurements: a method comparison study. World J Urol 27(6):747–753PubMedCrossRefGoogle Scholar
  10. 10.
    Kuhn A, Bank S, Robinson D, Klimek M, Kuhn P, Raio L (2010) How should bladder wall thickness be measured? a comparison of vaginal, perineal and abdominal ultrasound. Neurourol Urodyn 29(8):1393–1396PubMedCrossRefGoogle Scholar
  11. 11.
    Dorflinger A, Monga A (2001) Voiding dysfunction. Curr Opin Obstet Gynecol 13:507–512PubMedCrossRefGoogle Scholar
  12. 12.
    Zimmern PE, Hadley HR, Leach GE, Raz S (1987) Female urethral obstruction after Marshall–Marchetti–Kranz operation. J Urol 138:517–520PubMedGoogle Scholar
  13. 13.
    McDuffie RW, Litin RB, Blundon KE (2010) Urethrovesical suspension Marshall–Marchetti–Krantz Experience with 204 cases. Am J Surg 141:297–298CrossRefGoogle Scholar
  14. 14.
    Akpinal H, Cetinel B, Demirksen O (2008) Long-term results in Burch colposuspension. Int J Urol 7:119–125CrossRefGoogle Scholar
  15. 15.
    Ward KL, Hilton P, Browning J (2000) A randomized trial of colposuspension and tension-free vaginal tape for primary stress incontinence. Neurourol Urodyn 19:386–388Google Scholar
  16. 16.
    Holschneider CH, Solh S, Lebhertz TB, Montz FJ (1994) The modified Pereyra procedure in recurrent stress urinary incontinence: a 15-year review. Obstet Gynecol 83:573–578PubMedCrossRefGoogle Scholar
  17. 17.
    Karram MM, Segal JL, Vassallo BJ, Kleeman SD (2003) Complications and untoward effects of the tension-free vaginal tape procedure. Obstet Gynecol 101:929–932PubMedCrossRefGoogle Scholar
  18. 18.
    Blaivas JG, Groutz A (2000) Bladder outlet normogram for women with lower urinary tract symptomatology. Neurourol Urodyn 19:553–564PubMedCrossRefGoogle Scholar
  19. 19.
    Al-Hayek S, Belal M, Abrams P (2008) Does the patient’s position influence the detection of detrusor overactivity? Neurourol Urodynam 27:279–286CrossRefGoogle Scholar
  20. 20.
    Bump RC, Hurt WG, Elser DM, Theofrastous JP, Addison WA, Fantl JA (1999) Understanding lower urinary tract function in women soon after bladder neck surgery. Neurourol Urodyn 18:629–637PubMedCrossRefGoogle Scholar
  21. 21.
    Klutke JJ, Klutke CG, Bergman G, Elia G (1999) Urodynamic changes in voiding after anti-incontinence surgery: an insight into the mechanism of cure. Urology 54:1003–1007PubMedCrossRefGoogle Scholar
  22. 22.
    Abrams P, Roylance J, Feneley RC (1976) Excretion urography in the investigation of prostatism. Br J Urol 48:681–684PubMedCrossRefGoogle Scholar
  23. 23.
    Elbadawi A, Yalla SV, Resnick NM (1993) Structural basis of geriatric voiding dysfunction IV bladder outlet obstruction. J Urol 150:1681–1695PubMedGoogle Scholar
  24. 24.
    Belal M, Abrams P (2006) Noninvasive methods of diagnosing bladder outlet obstruction in men. Part I: Nonurodynamic approach. J Urol 176:22–28PubMedCrossRefGoogle Scholar
  25. 25.
    McConnel JD (1994) Why pressure flow studies should be optional and not mandatory for evaluating men with benign prostate hyperplasia. Urology 44:156–158CrossRefGoogle Scholar
  26. 26.
    Oelke M, Höfner K, Wiese B, Grünewald V, Jonas U (2002) Increase in detrusor wall thickness indicates bladder outlet obstruction in men. World J Urol 19(6):443–452PubMedGoogle Scholar
  27. 27.
    Segal J, Steele AC, Vassallo BJ, Kleeman S, Silva AW, Pauls R, Walsh P, Karram M (2006) Various surgical approaches to treat voiding dysfunction following anti-incontinence surgery. Int Urogynecol J 17:372–377CrossRefGoogle Scholar
  28. 28.
    Starkman JS, Duffy JW, Wolter CE, Kaufman MR, Scarpero HM, Dmochowski R (2008) The evolution of obstruction-induced overactive bladder symptoms following urethrolysis for female bladder outlet obstruction. J Urol 179:1018–1023PubMedCrossRefGoogle Scholar
  29. 29.
    Odorica R, Rodriguez AR, Coste-Delvecchio F, Hoffman M, Lockhart J (2008) Disabling conditions with slings for managing stress urinary incontinence. BJUI 102:333–336CrossRefGoogle Scholar
  30. 30.
    Starkman JS, Duffy JW, Wolter CE, Kaufman MR, Scarpero HM, Dmochowski RR (2008) The evolution of obstruction-induced overactive bladder symptoms following urethrolysis for female bladder outlet obstruction. J Urol 179:1018–1023PubMedCrossRefGoogle Scholar
  31. 31.
    McCrey R, Appell R (2007) Transvaginal urethrolysis for obstruction after anti-incontinence surgery. Int J Urogynecol J Pelvic Floor Dysfunct 18(6):627–633CrossRefGoogle Scholar
  32. 32.
    Kuhn A, Genoud S, Robinson D, Herrmann G, Guenthert AR, Brandner S, Raio L (2010) Sonographic transvaginal bladder wall thickness: does the measurement discriminate between urodynamic diagnoses? Neurourol Urodyn 26:1–4Google Scholar

Copyright information

© The International Urogynecological Association 2012

Authors and Affiliations

  • Annette Kuhn
    • 1
    Email author
  • Sonja Brandner
    • 1
  • Peter Kuhn
    • 2
  • Dudley Robinson
    • 3
  • Luigi Raio
    • 1
  1. 1.Urogynaecology, Department of GynaecologyUniversity Hospital and University of BernBernSwitzerland
  2. 2.Effingerzentrum BernBernSwitzerland
  3. 3.King’s CollegeLondonUK

Personalised recommendations