Skip to main content

Advertisement

Log in

Quantitative assessment of urethral vascularity in nulliparous females using high-frequency endovaginal ultrasonography

  • Topic Paper
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To assess the vascular parameters in the urethra of nulliparous females and to compare the vascularity among various parts of the urethra, using high-frequency endovaginal ultrasonography (EVUS).

Methods

Twenty-two nulliparous women, mean age 27 years, underwent EVUS using a biplane transducer at 12 MHz frequency. Color Doppler examinations of the urethra were recorded and further evaluated off-line using special software (Pixel Flux) for quantitative assessment of the vascularity. The urethra was divided into four regions of interest (ROIs) in the midsagittal plane and three ROIs in the axial plane. The following parameters were measured: velocity (V), perfused area (A), perfusion intensity (I), pulsatility index (PI), and resistance index (RI). Interobserver and intraobserver reproducibility analysis was also performed.

Results

In midsagittal plane, the midurethra presented the highest value of V and lowest value of A. The intramural part showed the lowest value of I and the highest values of RI and PI. In the distal urethra, the highest value of I and the lowest value of RI was seen. In the axial plane, the values of V, A, and I were statistically significantly higher in the external part of the midurethra compared with the internal part. Excellent interobserver and intraobserver reproducibility was shown in the majority of parameters for the entire urethra.

Conclusions

Vascularity differs in different parts of the urethra. Pixel Flux is a valuable tool for providing reproducible quantitative analysis of vascular parameters for the entire urethra.

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

Access this article

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

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ashton-Miller JA, DeLancey JO (2007) Functional anatomy of the female pelvic floor. Ann NY Acad Sci 1101:266–296

    Article  PubMed  Google Scholar 

  2. Caine M (1986) Peripheral factors in urinary continence. J Urol (Paris) 92(8):521–530

    CAS  Google Scholar 

  3. Jackson SR, Brookes S, Abrams P (2000) Measuring urethral blood flow using Doppler ultrasonography. BJU Int 86(7):910–917

    Google Scholar 

  4. Siracusano S, Bertolotto M, d’Aloia G, Silvestre G, Stener S (2001) Colour Doppler ultrasonography of female urethral vascularization in normal young volunteers: a preliminary report. BJU Int 88(4):378–381

    Article  PubMed  CAS  Google Scholar 

  5. Dietz HP (2004) Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol 23:80–92

    Article  PubMed  CAS  Google Scholar 

  6. Santoro GA, Wieczorek AP, Stankiewicz A, Wozniak MM, Bogusiewicz M, Rechberger T (2009) High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct 20(10):1213–1222

    Google Scholar 

  7. Wieczorek AP, Wozniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T (2010) 3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability. Eur J Radiol [Epub ahead of print]

  8. Scholbach T, Girelli E, Scholbach J (2006) Tissue pulsatility index: a new parameter to evaluate renal transplant perfusion. Transplantation 81(5):751–755

    Article  PubMed  Google Scholar 

  9. Scholbach T, Girelli E, Scholbach J (2005) Dynamic tissue perfusion measurement: a novel tool in follow-up of renal transplants. Transplantation 79(12):1711–1716

    Article  PubMed  Google Scholar 

  10. Scholbach T (2007) From the nutcracker-phenomenon of the left renal vein to the midline congestion syndrome as a cause of migraine, headache, back and abdominal pain and functional disorders of pelvic organs. Med Hypotheses 68(6):1318–1327

    Google Scholar 

  11. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al (1996) The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol 175(1):10–17

    Google Scholar 

  12. Scholbach T, Dimos I, Scholbach J (2004) A new method of color Doppler perfusion measurement via dynamic sonographic signal quantification in renal parenchyma. Nephron Physiol 96(4):99–104

    Article  Google Scholar 

  13. Wieczorek AP, Woźniak MM, Stankiewicz A, Bogusiewicz M, Santoro GA, Rechberger T et al (2009) The assessment of normal female urethral vascularity with Color Doppler endovaginal ultrasonography: preliminary report. Pelviperineology 28:59–61

    Google Scholar 

  14. Santoro GA, Wieczorek AP, Shobeiri SA, Mueller ER, Pilat J, Stankiewicz A, Battistella G (2011) Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic floor anatomy. Int Urogynecol J Pelvic Floor Dysfunct 22(1):53–59 Epub 2010 Aug 11

    Google Scholar 

  15. Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, Stankiewicz A, Bartram C (2011) State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol 37(4):381–396. doi:10.1002/uog.8816 (Review)

    Article  PubMed  CAS  Google Scholar 

  16. Wieczorek AP, Stankiewicz A, Santoro GA, Woźniak MM, Bogusiewicz M, Rechberger T (2011) Pelvic floor disorders: role of new ultrasonographic techniques. World J Urol [Epub ahead of print]

  17. Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet ii:307–310

  18. Macura KJ, Genadry R, Borman TL et al (2004) Evaluation of the female urethra with intraurethral magnetic resonance imaging. J Magn Reson Imaging 20:153–159

    Article  PubMed  Google Scholar 

  19. Digesu GA, Robinson D, Cardozo L et al (2009) Three-dimensional ultrasound of the urethral sphincter predicts continence surgery outcome. Neurourol Urodyn 28:90–94

    Article  PubMed  Google Scholar 

  20. Tunn R, Petri E (2003) Introital and transvaginal ultrasound as the main tool in the assessment of urogenital and pelvic floor dysfunction: an imaging panel and practical approach. Ultrasound Obstet Gynecol 22:205–213

    Article  PubMed  CAS  Google Scholar 

  21. Kobata SA, Girao MJ, Baracat EC, Kajikawa M, Di BV Jr, Sartori MG et al (2008) Estrogen therapy influence on periurethral vessels in postmenopausal incontinent women using Doppler velocimetry analysis. Maturitas 61(3):243–247

    Article  PubMed  CAS  Google Scholar 

  22. Yang JM, Yang SH, Huang WC (2006) Functional correlates of Doppler flow study of the female urethral vasculature. Ultrasound Obstet Gynecol 28(1):96–102

    Article  PubMed  Google Scholar 

  23. Miodrag A, Castleden CM, Vallance TR (1988) Sex hormones and the female urinary tract. Drugs 36(4):491–504

    Article  PubMed  CAS  Google Scholar 

  24. Sorensen S (1992) Urethral pressure variations in healthy and incontinence women: doctoral thesis. Neurourol Urodyn 141:817–820

    Google Scholar 

  25. Krumme B, Grotz W, Kirste G, Schollmeyer P, Rump LC (1997) Determinants of intrarenal Doppler indices in stable renal allografts. J Am Soc Nephrol 8(5):813–816

    PubMed  CAS  Google Scholar 

  26. Haderer JM, Pannu HK, Genadry R, Hutchins GM (2002) Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review. Int Urogynecol J Pelvic Floor Dysfunct 13(4):236–252

    Article  PubMed  CAS  Google Scholar 

  27. Siracusano S, Bertolotto M, Cucchi A, Lampropoulou N, Tiberio A, Gasparini C et al (2006) Application of ultrasound contrast agents for the characterization of female urethral vascularization in healthy pre- and postmenopausal volunteers: preliminary report. Eur Urol 50(6):1316–1322

    Article  PubMed  Google Scholar 

  28. Lien KC, Mooney B, DeLancey JO, Ashton-Miller JA (2004) Levator ani muscle stretch induced by simulated vaginal birth. Obstet Gynecol 103(1):31–40

    Article  PubMed  Google Scholar 

  29. Rechberger T, Futyma K, Jankiewicz K, Adamiak A, Bogusiewicz M, Bartuzi A, Miotła P, Skorupski P, Tomaszewski J (2011) Tape fixation: an important surgical step to improve success rate of anti-incontinence surgery. J Urol 186(1):180–184. Epub 2011 May 14

    Google Scholar 

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Magdalena Maria Woźniak.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wieczorek, A.P., Woźniak, M.M., Stankiewicz, A. et al. Quantitative assessment of urethral vascularity in nulliparous females using high-frequency endovaginal ultrasonography. World J Urol 29, 625–632 (2011). https://doi.org/10.1007/s00345-011-0732-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-011-0732-x

Keywords

Navigation