Skip to main content

Advertisement

SpringerLink
Log in

Urethral sphincter volume and urodynamic diagnosis

  • Original Article
  • Published:
International Urogynecology Journal Aims and scope Submit manuscript

Abstract

Aim

To compare urethral sphincter measurements in women with different urodynamic diagnoses using three-dimensional transperineal ultrasound (TPU).

Methods

Women with lower urinary tract dysfunction having urodynamic studies (UDS) were prospectively recruited to this study. A detailed history and vaginal examination were conducted. Saline cystometry was performed and the women were divided into groups according to their urodynamic diagnosis, which were nondiagnostic urodynamics (NUDS), pure detrusor overactivity (PureDO), pure urodynamic stress incontinence (PureUSI) and mixed urinary incontinence (MUDS). Three-dimensional TPU was performed to measure total urethral sphincter volume, striated sphincter volume, core volume, sphincter length and maximum cross-sectional area. The ultrasound measurements were compared with the diagnostic urodynamics.

Results

One hundred fifty women were included in the study. There were 37, 53, 22 and 38 women in the groups of NUDS, PureDO, PureUSI and MUDS respectively. The average striated sphincter volumes in these groups were 1.84 ml, 2.24 ml, 1.32 ml and 1.98 ml respectively. There was no difference in average age, body mass index or presence of prolapse in these groups. All measurements were larger in the PureDO and smaller in the PureUSI group compared with the NUDS group. The measurements in the MUDS group were larger than in the NUDS group and smaller than in the PureDO group but this difference was not statistically significant.

Conclusion

The urethral sphincter of women with PureDO is larger than in women with PureUSI. The value in women with MUDS was between the two. The size of the urethral sphincter appears to be related to the pathophysiology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Mistry MA, Klarskov N, DeLancey JO, Lose G. A structured review on the female urethral anatomy and innervation with an emphasis on the role of the urethral longitudinal smooth muscle. Int Urogynecol J. 2019.

  2. Rud T. The effects of estrogens and gestagens on the urethral pressure profile in urinary continent and stress incontinent women. Acta Obstet Gynecol Scand. 1980;59:265–70.

    Article  CAS  Google Scholar 

  3. Khayyami Y, Lose G, Klarskov N. The urethral closure mechanism is deteriorated after anterior colporrhaphy. Int Urogynecol J. 2018;29:1311–6.

    Article  Google Scholar 

  4. Khullar V, Athanasiou S, Cardozo L, Boos K, Salvatore S, Young M. Histological correlates of the urethral sphincter and surrounding structures with ultrasound imaging, 21st Annual meeting of International Urogynaecology Association, abstract 47. 1996.

  5. Athanasiou S, Khullar V, Boos K, Salvatore S, Cardozo L. Imaging the urethral sphincter with three-dimensional ultrasound. Obstet Gynecol. 1999;94:295–301.

    CAS  PubMed  Google Scholar 

  6. Shui W, Luo Y, Ying T, Li Q, Dou C, Zhou M. Assessment of female pelvic floor support to the urethra using 3D transperineal ultrasound. Int Urogynecol J. 2019.

  7. Kirschner-Hermanns R, Klein HM, Muller U, Schafer W, Jakse G. Intra-urethral ultrasound in women with stress incontinence. Br J Urol. 1994;74:315–8.

    Article  CAS  Google Scholar 

  8. Frauscher F, Helweg G, Strasser H, Enna B, Klauser A, Knapp R, et al. Intraurethral ultrasound: diagnostic evaluation of the striated urethral sphincter in incontinent females. Eur Radiol. 1998;8:50–3.

    Article  CAS  Google Scholar 

  9. van de Waarsenburg MK, van Hoogenhuijze NE, Grob ATM, Schweitzer KJ, Withagen MIJ, van der Vaart CH. Method and reliability of measuring midurethral area and echogenicity, and changes during and after pregnancy. Int Urogynecol J. 2018;29:1379–85.

    Article  Google Scholar 

  10. Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international Urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Int Urogynecol J. 2010;21:5–26.

    Article  Google Scholar 

  11. Delancey JO. Correlative study of paraurethral anatomy. Obstet Gynecol. 1986;68:91–7.

    CAS  PubMed  Google Scholar 

  12. Digesu GA, Calandrini N, Derpapas A, Gallo P, Ahmed S, Khullar V. Intraobserver and interobserver reliability of the three-dimensional ultrasound imaging of female urethral sphincter using a translabial technique. Int Urogynecol J. 2012;23:1063–8.

    Article  Google Scholar 

  13. Altman DG. Statistics and ethics in medical research: III how large a sample? Br Med J. 1980;281:1336–8.

    Article  CAS  Google Scholar 

  14. Blaganje M, Lukanovic A. Ultrasound-guided autologous myoblast injections into the extrinsic urethral sphincter: tissue engineering for the treatment of stress urinary incontinence. Int Urogynecol J. 2013;24:533–5.

    Article  Google Scholar 

  15. Athanasiou S, Chaliha C, Digesu GA, Sotiropoulou M, Georgoulias N, Khullar V, et al. The effects of duloxetine on urethral function and sphincter morphology. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:763–7.

    Article  Google Scholar 

  16. Madill SJ, Pontbriand-Drolet S, Tang A, Dumoulin C. Changes in urethral sphincter size following rehabilitation in older women with stress urinary incontinence. Int Urogynecol J. 2015;26:277–83.

    Article  Google Scholar 

  17. Noble JG, Dixon PJ, Rickards D, Fowler CJ. Urethral sphincter volumes in women with obstructed voiding and abnormal sphincter electromyographic activity. Br J Urol. 1995;76:741–6.

    Article  CAS  Google Scholar 

  18. Malallah MA, Al-Shaiji TF. Pharmacological treatment of pure stress urinary incontinence: a narrative review. Int Urogynecol J. 2015;26:477–85.

    Article  Google Scholar 

  19. Duckett J, Patil A, Aggarwal I. The effect of duloxetine on urethral sphincter morphology. Ultrasound Obstet Gynecol. 2008;31:206–9.

    Article  CAS  Google Scholar 

  20. Duckett J, Basu M. The effect of solifenacin on urethral sphincter morphology. Int Urogynecol J. 2011;22:971–4.

    Article  Google Scholar 

  21. Bodner-Adler B, Alarab M, Ruiz-Zapata AM, Latthe P. Effectiveness of hormones in postmenopausal pelvic floor dysfunction-International Urogynecology Association research and development-committee opinion. Int Urogynecol J. 2019.

  22. Dietz HP, Socha M, Atan IK, Subramaniam N. Does estrogen deprivation affect pelvic floor muscle contractility? Int Urogynecol J. 2019. Dietz HP, Socha M, Atan IK, Subramaniam N. Does estrogen deprivation affect pelvic floor muscle contractility? Int Urogynecol J. 2019.

  23. Cassado Garriga J, Pessarrodona Isern A, Rodriguez Carballeira M, Pallarols Badia M, Moya Del Corral M, Valls Esteve M, et al. Three-dimensional translabial ultrasound assessment of urethral supports and the urethral sphincter complex in stress urinary incontinence. Neurourol Urodyn. 2017;36:1839–45.

    Article  Google Scholar 

  24. Robinson D, Toozs-Hobson P, Cardozo L, Digesu A. Correlating structure and function: three-dimensional ultrasound of the urethral sphincter. Ultrasound Obstet Gynecol. 2004;23:272–6.

    Article  CAS  Google Scholar 

  25. Bump R, Huang KC, McClish D, Fantl JA. Effect of narcotic anaesthesia and skeletal muscle paralysis on passive and dynamic urethral function of stress continent and incontinent women. Neurourol Urodyn. 1991;10:523–32.

    Article  Google Scholar 

  26. Haeusler G, Sam C, Chiari A, Tempfer C, Hanzal E, Koelbl H. Effect of spinal anaesthesia on the lower urinary tract in continent women. Br J Obstet Gynaecol. 1998;105:103–6.

    Article  CAS  Google Scholar 

  27. Mitchell WK, Williams J, Atherton P, Larvin M, Lund J, Narici M. Sarcopenia, dynapenia, and the impact of advancing age on human skeletal muscle size and strength; a quantitative review. Front Physiol. 2012;3:260.

    Article  Google Scholar 

  28. Robinson D, Akervall S, Wagg A, Chapple C, Milsom I, Gyhagen M. Prevalence and predictors of overactive bladder in nonpregnant nulliparous women below 65 years of age. Int Urogynecol J. 2018;29:531–7.

    PubMed  Google Scholar 

  29. Juliato CR, Baccaro LF, Pedro AO, Gabiatti JR, Lui-Filho JF, Costa-Paiva L. Factors associated with urinary incontinence in middle-aged women: a population-based household survey. Int Urogynecol J. 2017;28:423–9.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Chelsea and Westminster NHS Foundation Trust, London, UK

    Roopali Karmarkar

  2. Imperial College London, London, UK

    Alex Digesu, Ruwan Fernando & Vik Khullar

Authors
  1. Roopali Karmarkar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alex Digesu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ruwan Fernando
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vik Khullar
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

R Karmarkar: Project development, Data collection, Data analysis, Manuscript writing.

A Digesu: Manuscript review.

R Fernando: Manuscript review.

V Khullar: Project supervision, Manuscript editing.

Part of this work was presented at the International Continence Society’s Annual Conference in Tokyo on 14/09/2016.

Corresponding author

Correspondence to Roopali Karmarkar.

Ethics declarations

Conflict of interest

There is no conflict of interest to declare for any authors.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karmarkar, R., Digesu, A., Fernando, R. et al. Urethral sphincter volume and urodynamic diagnosis. Int Urogynecol J 31, 2589–2594 (2020). https://doi.org/10.1007/s00192-020-04409-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00192-020-04409-y

Keywords

Search

Navigation