Urethral length and bladder neck behavior: can dynamic magnetic resonance imaging give the same results as introital ultrasound?

  • C. D. Alt
  • S. M. Katzenberger
  • P. Hallscheidt
  • C. Sohn
  • H. U. Kauczor
  • S. B. Eickhoff
  • K. A. BrockerEmail author
General Gynecology



To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes.


Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women—scheduled for surgical treatment with alloplastic material—who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis.


Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6–3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67–74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50–72%.


Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.


Introital ultrasound Dynamic magnetic resonance imaging Urethral length measurement Bladder neck descent Urethral funneling 


Author contributions

CDA: data analysis, manuscript writing, and manuscript editing. SMK: data collection and data management. PH: protocol development and manuscript editing. CS: project development and manuscript editing. HUK: project development. SBE: statistical analysis, data analysis, and manuscript editing. KAB: protocol development, data management, data analysis, and manuscript editing


The trial was self-funded.

Compliance with ethical standards

Conflict of interest

KA Brocker reports personal fees in the past by Serag Wiessner, Naila, Germany, outside the submitted work. All other authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants who were included in the study.

Supplementary material

404_2019_5060_MOESM1_ESM.tif (3.4 mb)
Indication for surgery and determination of the surgical approach were set by the urogynecologist based on clinical examination; dMRI had no influence on this determination. The alloplastic material that was used was a vaginal mesh, produced by Serag Wiessner GmbH & Co. KG, Naila, Germany (Seratom A PA® four-arm-approach; Seratom E PA®, transobturatory and sacrospinous six-arm-approach with additional sacrospinous fixation) or by American Medical Systems, Inc., Minnetonka, MN, USA (PerigeeTM, Transobturator Anterior Prolapse Repair System), a transobturator tape or a tension-free vaginal tape, produced by Serag Wiessner GmbH & Co. KG, Naila, Germany (SERASIS® / SERASIS®PA). US ultrasound; CE clinical examination; TOT transobturator tape; TVT transvaginal tape; vH vaginal hysterectomy; AC anterior colporrhaphy; AM anterior mesh; PM posterior mesh


  1. 1.
    Nitti VW (2001) The prevalence of urinary incontinence. Rev Urol 3:S2–6. Google Scholar
  2. 2.
    Giarenis I, Robinson D (2014) Prevention and management of pelvic organ prolapse. F1000Prime Rep 6:77. CrossRefGoogle Scholar
  3. 3.
    Brocker KA, Alt CD, Rzepka J, Sohn C, Hallscheidt P (2015) 1-year dynamic MRI follow-up after vaginal mesh repair: evaluation of clinical, radiological, and quality-of-life results. Acta Radiol 56:1002–1008. CrossRefGoogle Scholar
  4. 4.
    Farthmann J, Watermann D, Niesel A, Funfgeld C, Kraus A, Lenz F, Augenstein HJ, Graf E, Gabriel B (2013) Lower exposure rates of partially absorbable mesh compared to nonabsorbable mesh for cystocele treatment: 3-year follow-up of a prospective randomized trial. Int Urogynecol J 24:749–758. CrossRefGoogle Scholar
  5. 5.
    Gabriel B, Farthmann J, Brintrup B, Funfgeld C, Jezek P, Kraus A, Lenz F, Kumbier E, Niesel A, Stickeler E, Watermann D (2007) Surgical repair of posterior compartment prolapse: preliminary results of a novel transvaginal procedure using a four-armed polypropylene mesh with infracoccygeal and pararectal suspension. Acta Obstet Gynecol Scand 86:1236–1242. CrossRefGoogle Scholar
  6. 6.
    de Tayrac R, Deffieux X, Gervaise A, Chauveaud-Lambling A, Fernandez H (2006) Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh. Int Urogynecol J Pelvic Floor Dysfunct 17:483–488. CrossRefGoogle Scholar
  7. 7.
    Comiter C, Vasavada S, Barbaric Z, Gousse AE, Raz S (1999) Grading pelvic prolapse and pelvic floor relaxation using dynamic magnetic resonance imaging. Urology 54:454–457CrossRefGoogle Scholar
  8. 8.
    Alt CD, Brocker KA, Lenz F, Sohn C, Kauczor HU, Hallscheidt P (2014) MRI findings before and after prolapse surgery. Acta Radiol 55:495–504. CrossRefGoogle Scholar
  9. 9.
    Chamié LP, Ribeiro DMFR, Caiado AHM, Warmbrand G, Serafini PC (2018) Translabial US and Dynamic MR Imaging of the Pelvic Floor: normal Anatomy and Dysfunction. RadioGraphics 38:287–308. CrossRefGoogle Scholar
  10. 10.
    Pomian A, Majkusiak W, Kociszewski J, Tomasik P, Horosz E, Zwierzchowska A, Lisik W, Barcz E (2018) Demographic features of female urethra length. Neurourol Urodyn 37:1751–1756. CrossRefGoogle Scholar
  11. 11.
    Westby M, Asmussen M, Ulmsten U (1982) Location of maximum intraurethral pressure related to urogenital diaphragm in the female subject as studied by simultaneous urethrocystometry and voiding urethrocystography. Am J Obstet Gynecol 144:408–412. CrossRefGoogle Scholar
  12. 12.
    Jiang YH, Wang CC, Chuang FC, Ke QS, Kuo HC (2013) Positioning of a suburethral sling at the bladder neck is associated with a higher recurrence rate of stress urinary incontinence. J Ultrasound Med 32:239–245. CrossRefGoogle Scholar
  13. 13.
    Kociszewski J, Fabian G, Grothey S, Kuszka A, Zwierzchowska A, Majkusiak W, Barcz E (2017) Are complications of stress urinary incontinence surgery procedures associated with the position of the sling? Int J Urol 24:145–150. CrossRefGoogle Scholar
  14. 14.
    Viereck V, Pauer HU, Bader W, Oppermann M, Hilgers R, Gauruder-Burmester A, Lange R, Emons G, Hackenberg R, Krauss T (2004) Introital ultrasound of the lower genital tract before and after colposuspension: a 4-year objective follow-up. Ultrasound Obstet Gynecol 23:277–283. CrossRefGoogle Scholar
  15. 15.
    Harms L, Emons G, Bader W, Lange R, Hilgers R, Viereck V (2007) Funneling before and after anti-incontinence surgery—a prognostic indicator? Part 2: tension-free vaginal tape. Int Urogynecol J Pelvic Floor Dysfunct 18:289–294. CrossRefGoogle Scholar
  16. 16.
    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 93:412–416. Google Scholar
  17. 17.
    Dietz HP, Wilson PD (1999) The influence of bladder volume on the position and mobility of the urethrovesical junction. Int Urogynecol J 10:3–6. CrossRefGoogle Scholar
  18. 18.
    Tunn R, Albrich S, Beilecke K et al (2014) Interdisciplinary S2 k guideline: sonography in urogynecology interdisziplinäre S2 k-Leitlinie: sonografie im rahmen der urogynäkologischen diagnostik 1 general recommendation. Geburtshilfe Frauenheilkd 74:1093–1098. CrossRefGoogle Scholar
  19. 19.
    Wlaźlak E, Kociszewski J, Suzin J, Dresler M, Surkont G (2016) Urethral length measurement in women during sonographic urethrocystography—an analysis of repeatability and reproducibility. J Ultrason 16:25–31. CrossRefGoogle Scholar
  20. 20.
    Dietz HP, Nazemian K, Shek KL, Martin A (2013) Can urodynamic stress incontinence be diagnosed by ultrasound? Int Urogynecol J Pelvic Floor Dysfunct 24:1399–1403. CrossRefGoogle Scholar
  21. 21.
    Chen L, Lenz F, Alt CD, Sohn C, De Lancey JO, Brocker KA (2017) MRI visible Fe3O4 polypropylene mesh: 3D reconstruction of spatial relation to bony pelvis and neurovascular structures. Int Urogynecol J 28:1131–1138. CrossRefGoogle Scholar
  22. 22.
    Gufler H, DeGregorio G, Dohnicht S, Allmann KH, Rohr-Reyes A (2002) Dynamic MRI after surgical repair for pelvic organ prolapse. J Comput Assist Tomogr 26:734–739. CrossRefGoogle Scholar
  23. 23.
    Umek WH, Kearney R, Morgan DM, Ashton-Miller JA, DeLancey JO (2003) The axial location of structural regions in the urethra: a magnetic resonance study in nulliparous women. Obstet Gynecol 102:1039–1045. Google Scholar
  24. 24.
    Nager CW, Kraus SR, Kenton K, Sirls L, Chai TC, Wai C, Sutkin G, Leng W, Litman H, Huang L, Tennstedt S, Richter HE, Urinary Incontinence Treatment Network (2010) Urodynamics, the supine empty bladder stress test, and incontinence severity. Neurourol Urodyn 29:1306–1311. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diagnostic and Interventional RadiologyUniversity Duesseldorf, Medical FacultyDuesseldorfGermany
  2. 2.Department of Obstetrics and Gynecology, Medical SchoolUniversity of HeidelbergHeidelbergGermany
  3. 3.Department of Diagnostic and Interventional RadiologyUniversity Heidelberg, Medical FacultyHeidelbergGermany
  4. 4.Institute of Neuroscience and Medicine (INM-7)Juelich Research CentreJuelichGermany
  5. 5.Institute of Systems NeuroscienceHeinrich Heine UniversityDusseldorfGermany
  6. 6.Radiological Department Darmstadt, Academic Teaching PracticeUniversity of Heidelberg Medical CenterDarmstadtGermany
  7. 7.Hannover Medical School, Clinic of OrthodonticsHannoverGermany

Personalised recommendations