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Endovaginal Urethra and Bladder Imaging

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Abstract

The chapter describes currently available endovaginal 3D ultrasound techniques applied in the urethral and bladder imaging. Various ultrasound modalities, transducers, and anatomical approaches used in the assessment of female urethra and bladder with reference to other pelvic floor structures are described. Present possibilities of each method are demonstrated, including practical information and tips on how to obtain reliable diagnostic images. The advantages and limitations of each method and each transducers are shown as well as their clinical usefulness in the integrated diagnostics of urethra and bladder.

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References

  1. Petros PE, Ulmsten UI. An integral theory and its method for the diagnosis and management of female urinary incontinence. Scand J Urol Nephrol Suppl. 1993;153:1–93. PubMed PMID: 8108659.

    CAS  PubMed  Google Scholar 

  2. Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7–31. PubMed PMID: 2093278.

    Article  CAS  PubMed  Google Scholar 

  3. Petros PE, Woodman PJ. The integral theory of continence. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(1):35–40. PubMed PMID: 17968480.

    PubMed  Google Scholar 

  4. Santoro GA, Wieczorek AP, Shobeiri SA, Mueller ER, Pilat J, Stankiewicz A, et al. Interobserver and interdisciplinary reproducibility of 3D endovaginal ultrasound assessment of pelvic floor anatomy. Int Urogynecol J. 2011;22(1):53–9. PubMed PMID: 20700728.

    Article  PubMed  Google Scholar 

  5. Santoro GA, Wieczorek AP, Stankiewicz A, Wozniak MM, Bogusiewicz M, Rechberger T. High-resolution three-dimensional endovaginal ultrasonography in the assessment of pelvic floor anatomy: a preliminary study. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(10):1213–22. PubMed PMID: 19533007.

    Article  PubMed  Google Scholar 

  6. 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. Neurourol Urodyn. 2010;29(1):4–20. PubMed PMID: 19941278.

    PubMed  Google Scholar 

  7. Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, Athanasiou S, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Neurourol Urodyn. 2012;31(4):415–21. PubMed PMID: 22517068.

    Article  PubMed  Google Scholar 

  8. Stankiewicz A, Wieczorek AP, Wozniak MM, Bogusiewicz M, Futyma K, Santoro GA, Rechberger T. Comparison of accuracy of functional measurements of the urethra in transperineal vs. endovaginal ultrasound in incontinent women. Pelviperineology. 2008;27:145–7.

    Google Scholar 

  9. Santoro GA, Fortling B. The advantages of volume rendering in three-dimensional endosonography of the anorectum. Dis Colon Rectum. 2007;50(3):359–68. PubMed PMID: 17237912.

    Article  PubMed  Google Scholar 

  10. Santoro GA, Wieczorek AP, Shobeiri SA, Stankiewicz A. Endovaginal ultrasonography: methodology and normal pelvic floor anatomy. In: Santoro GA, Wieczorek AP, Bartram CI, editors. Pelvic floor disorders: imaging and multidisciplinary approach to management. Dordrecht: Springer; 2010. p. 61–78.

    Chapter  Google Scholar 

  11. Wieczorek AP, Wozniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T. 3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of inter-observer reliability. Eur J Radiol. 2012;81(1):e7–12. PubMed PMID: 20970275.

    Article  CAS  PubMed  Google Scholar 

  12. Shobeiri SA, Leclaire E, Nihira MA, Quiroz LH, O’Donoghue D. Appearance of the levator ani muscle subdivisions in endovaginal three-dimensional ultrasonography. Obstet Gynecol. 2009;114(1):66–72. PubMed PMID: 19546760.

    PubMed  Google Scholar 

  13. Petros PP. Medium-term follow-up of the intravaginal slingplasty operation indicates minimal deterioration of urinary continence with time. Aust N Z J Obstet Gynaecol. 1999;39(3):354–6. PubMed PMID: 10554951.

    Article  CAS  PubMed  Google Scholar 

  14. Digesu GA, Robinson D, Cardozo L, Khullar V. Three-dimensional ultrasound of the urethral sphincter predicts continence surgery outcome. Neurourol Urodyn. 2009;28(1):90–4. PubMed PMID: 18726938.

    Article  PubMed  Google Scholar 

  15. Umek WH, Laml T, Stutterecker D, Obermair A, Leodolter S, Hanzal E. The urethra during pelvic floor contraction: observations on three-dimensional ultrasound. Obstet Gynecol. 2002;100(4):796–800. PubMed PMID: 12383551.

    Article  PubMed  Google Scholar 

  16. Umek WH, Obermair A, Stutterecker D, Hausler G, Leodolter S, Hanzal E. Three-dimensional ultrasound of the female urethra: comparing transvaginal and transrectal scanning. Ultrasound Obstet Gynecol. 2001;17(5):425–30. PubMed PMID: 11380968.

    Article  CAS  PubMed  Google Scholar 

  17. Derpapas A, Ahmed S, Vijaya G, Digesu GA, Regan L, Fernando R, et al. Racial differences in female urethral morphology and levator hiatal dimensions: an ultrasound study. Neurourol Urodyn. 2012;31(4):502–7. PubMed PMID: 22190140.

    Article  PubMed  Google Scholar 

  18. Shobeiri SA, White D, Quiroz LH, Nihira MA. Anterior and posterior compartment 3D endovaginal ultrasound anatomy based on direct histologic comparison. Int Urogynecol J. 2012;23(8):1047–53. PubMed PMID: 22402641.

    Article  PubMed  Google Scholar 

  19. Kondo Y, Homma Y, Takahashi S, Kitamura T, Kawabe K. Transvaginal ultrasound of urethral sphincter at the mid urethra in continent and incontinent women. J Urol. 2001;165(1):149–52. PubMed PMID: 11125385.

    Article  CAS  PubMed  Google Scholar 

  20. Macura KJ, Genadry R, Borman TL, Mostwin JL, Lardo AC, Bluemke DA. Evaluation of the female urethra with intraurethral magnetic resonance imaging. J Magn Reson Imaging. 2004;20(1):153–9. PubMed PMID: 15221821.

    Article  PubMed  Google Scholar 

  21. 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(1):50–3. PubMed PMID: 9442128.

    Article  CAS  PubMed  Google Scholar 

  22. Haderer JM, Pannu HK, Genadry R, Hutchins GM. Controversies in female urethral anatomy and their significance for understanding urinary continence: observations and literature review. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(4):236–52. PubMed PMID: 12189429.

    Article  CAS  PubMed  Google Scholar 

  23. Howard D, Delancey JO, Tunn R, Ashton-Miller JA. Racial differences in the structure and function of the stress urinary continence mechanism. Obstet Gynecol. 2000;95(5):713–7. PubMed PMID: 10775735. Pubmed Central PMCID: 1283097.

    Article  CAS  PubMed  Google Scholar 

  24. Ashton-Miller JA, DeLancey JO. Functional anatomy of the female pelvic floor. Ann N Y Acad Sci. 2007;1101:266–96. PubMed PMID: 17416924.

    Article  PubMed  Google Scholar 

  25. Caine M. Peripheral factors in urinary continence. J Urol (Paris). 1986;92(8):521–30.

    CAS  Google Scholar 

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

    Google Scholar 

  27. Siracusano S, Bertolotto M, d’Aloia G, Silvestre G, Stener S. Colour Doppler ultrasonography of female urethral vascularization in normal young volunteers: a preliminary report. BJU Int. 2001;88(4):378–81. PubMed PMID: 11564025.

    Article  CAS  PubMed  Google Scholar 

  28. Siracusano S, Bertolotto M, Cucchi A, Lampropoulou N, Tiberio A, Gasparini C, et al. Application of ultrasound contrast agents for the characterization of female urethral vascularization in healthy pre- and postmenopausal volunteers: preliminary report. Eur Urol. 2006;50(6):1316–22. PubMed PMID: 16831513.

    Article  PubMed  Google Scholar 

  29. Wieczorek AP, Wozniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T, et al. Quantitative assessment of urethral vascularity in nulliparous females using high-frequency endovaginal ultrasonography. World J Urol. 2011;29(5):625–32. PubMed PMID: 21796481.

    Article  PubMed  Google Scholar 

  30. Wieczorek AP, Wozniak MM, Stankiewicz A, Bogusiewicz M, Santoro GA, Rechberger T, Scholbach J. The assessment of normal female urethral vascularity with Color Doppler endovaginal ultrasonography: preliminary report. Pelviperineology. 2009;28:59–61.

    Google Scholar 

  31. Lone F. (2012) Vascularity of the Urethra in urinary continent women using colour Doppler high-frequency endovaginal ultrasonography (EVUS). 37th Annual Meeting of International Urogynaecological Association (IUGA), Brisbane, Australia, 4–8 September 2012.

    Google Scholar 

  32. Chaudhari VV, Patel MK, Douek M, Raman SS. MR imaging and US of female urethral and periurethral disease. Radiographics. 2010;30(7):1857–74. PubMed PMID: 21057124.

    Article  PubMed  Google Scholar 

  33. Albers P, Foster RS, Bihrle R, Adams MC, Keating MA. Ectopic ureters and ureteroceles in adults. Urology. 1995;45(5):870–4. PubMed PMID: 7747379.

    Article  CAS  PubMed  Google Scholar 

  34. Wang S, Lang JH, Zhou HM. Symptomatic urinary problems in female genital tract anomalies. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20(4):401–6. PubMed PMID: 19093064.

    Article  PubMed  Google Scholar 

  35. Tunn R, Schaer G, Peschers U, Bader W, Gauruder A, Hanzal E, et al. Updated recommendations on ultrasonography in urogynecology. Int Urogynecol J Pelvic Floor Dysfunct. 2005;16(3):236–41. PubMed PMID: 15875241.

    Article  CAS  PubMed  Google Scholar 

  36. Yang JM, Huang WC, Yang SH. Transvaginal sonography in the diagnosis, management and follow-up of complex paraurethral abnormalities. Ultrasound Obstet Gynecol. 2005;25(3):302–6. PubMed PMID: 15693039.

    Article  PubMed  Google Scholar 

  37. Kawashima A, Sandler CM, Wasserman NF, LeRoy AJ, King Jr BF, Goldman SM. Imaging of urethral disease: a pictorial review. Radiographics. 2004;24 Suppl 1:S195–216. PubMed PMID: 15486241.

    Article  PubMed  Google Scholar 

  38. Huang WC, Yang SH, Yang SY, Yang E, Yang JM. Vaginal abscess mimicking a cystocele and causing voiding dysfunction after burch colposuspension. J Ultrasound Med. 2009;28(1):63–6. PubMed PMID: 19106358.

    CAS  PubMed  Google Scholar 

  39. Rostaminia G, White DE, Quiroz LH, Shobeiri SA. Visualization of periurethral structures by 3D endovaginal ultrasonography in midsagittal plane is not associated with stress urinary incontinence status. Int Urogynecol J. 2013;24(7):1145–50. doi: 10.1007/s00192-012-1990-x. Epub 2012 Nov 24. PubMed PMID: 23179501.

  40. Yang JM, Yang SH, Huang WC. Two- and three-dimensional sonographic findings in a case of distal urethral obstruction due to a paraurethral tumor. Ultrasound Obstet Gynecol. 2005;25(5):519–21. PubMed PMID: 15846764.

    Article  PubMed  Google Scholar 

  41. Schaer GN, Perucchini D, Munz E, Peschers U, Koechli OR, Delancey JO. Sonographic evaluation of the bladder neck in continent and stress-incontinent women. Obstet Gynecol. 1999;93(3):412–6. PubMed PMID: 10074990.

    Article  CAS  PubMed  Google Scholar 

  42. Dietz HP. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol. 2004;23(1):80–92. PubMed PMID: 14971006.

    Article  CAS  PubMed  Google Scholar 

  43. Huang WC, Yang JM. Bladder neck funneling on ultrasound cystourethrography in primary stress urinary incontinence: a sign associated with urethral hypermobility and intrinsic sphincter deficiency. Urology. 2003;61(5):936–41. PubMed PMID: 12736011.

    Article  PubMed  Google Scholar 

  44. Tunn R, Goldammer K, Gauruder-Burmester A, Wildt B, Beyersdorff D. Pathogenesis of urethral funneling in women with stress urinary incontinence assessed by introital ultrasound. Ultrasound Obstet Gynecol. 2005;26(3):287–92. PubMed PMID: 16082725.

    Article  CAS  PubMed  Google Scholar 

  45. Dietz HP, Clarke B, Herbison P. Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence. Int Urogynecol J Pelvic Floor Dysfunct. 2002;13(5):289–93. PubMed PMID: 12355287.

    Article  CAS  PubMed  Google Scholar 

  46. Petros PP, Von Konsky B. Anchoring the midurethra restores bladder-neck anatomy and continence. Lancet. 1999;354(9183):997–8. PubMed PMID: 10501364.

    Article  CAS  PubMed  Google Scholar 

  47. Hall RJ, Rogers RG, Saiz L, Qualls C. Translabial ultrasound assessment of the anal sphincter complex: normal measurements of the internal and external anal sphincters at the proximal, mid-, and distal levels. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18(8):881–8. PubMed PMID: 17221149.

    Article  PubMed  Google Scholar 

  48. Khullar V, Salvatore S, Cardozo L, Bourne TH, Abbott D, Kelleher C. A novel technique for measuring bladder wall thickness in women using transvaginal ultrasound. Ultrasound Obstet Gynecol. 1994;4(3):220–3. PubMed PMID: 12797185.

    Article  CAS  PubMed  Google Scholar 

  49. Khullar V, Cardozo LD, Salvatore S, Hill S. Ultrasound: a noninvasive screening test for detrusor instability. Br J Obstet Gynaecol. 1996;103(9):904–8. PubMed PMID: 8813311.

    Article  CAS  PubMed  Google Scholar 

  50. Klauser A, Frauscher F, Strasser H, Helweg G, Kolle D, Strohmeyer D, et al. Age-related rhabdosphincter function in female urinary stress incontinence: assessment of intraurethral sonography. J Ultrasound Med. 2004;23(5):631–7. PubMed PMID: 15154529. quiz 8–9.

    PubMed  Google Scholar 

  51. Perucchini D, DeLancey JO, Ashton-Miller JA, Galecki A, Schaer GN. Age effects on urethral striated muscle. II. Anatomic location of muscle loss. Am J Obstet Gynecol. 2002;186(3):356–60. PubMed PMID: 11904591.

    Article  PubMed  Google Scholar 

  52. Perucchini D, DeLancey JO, Ashton-Miller JA, Peschers U, Kataria T. Age effects on urethral striated muscle. I. Changes in number and diameter of striated muscle fibers in the ventral urethra. Am J Obstet Gynecol. 2002;186(3):351–5. PubMed PMID: 11904590.

    Article  PubMed  Google Scholar 

  53. Wieczorek AP, Woźniak MM, Stankiewicz A. Ultrasonography. In: Santoro GA, Wieczorek AP, Bartram CI, editors. Pelvic floor disorders: imaging and multidisciplinary approach to management. Dordrecht: Springer; 2010. p. 175–87.

    Chapter  Google Scholar 

  54. Santoro GA, Wieczorek AP, Woźniak MM, Stankiewicz A. Endoluminal ultrasonography. In: Santoro GA, Wieczorek AP, Bartram CI, editors. Pelvic floor disorders: imaging and multidisciplinary approach to management. Dordrecht: Springer; 2010. p. 389–403.

    Chapter  Google Scholar 

  55. Dietz HP, Wilson PD. Anatomical assessment of the bladder outlet and proximal urethra using ultrasound and videocystourethrography. Int Urogynecol J Pelvic Floor Dysfunct. 1998;9(6):365–9. PubMed PMID: 9891957.

    Article  CAS  PubMed  Google Scholar 

  56. Gordon D, Pearce M, Norton P, Stanton SL. Comparison of ultrasound and lateral chain urethrocystography in the determination of bladder neck descent. Am J Obstet Gynecol. 1989;160(1):182–5. PubMed PMID: 2643321.

    Article  CAS  PubMed  Google Scholar 

  57. Kociszewski J, Rautenberg O, Kolben S, Eberhard J, Hilgers R, Viereck V. Tape functionality: position, change in shape, and outcome after TVT procedure–mid-term results. Int Urogynecol J. 2010;21(7):795–800. PubMed PMID: 20204326. Pubmed Central PMCID: 2876268.

    Article  PubMed  Google Scholar 

  58. Kociszewski J, Rautenberg O, Perucchini D, Eberhard J, Geissbuhler V, Hilgers R, et al. Tape functionality: sonographic tape characteristics and outcome after TVT incontinence surgery. Neurourol Urodyn. 2008;27(6):485–90. PubMed PMID: 18288705.

    Article  PubMed  Google Scholar 

  59. Chantarasorn V, Shek KL, Dietz HP. Sonographic appearance of transobturator slings: implications for function and dysfunction. Int Urogynecol J. 2011;22(4):493–8. PubMed PMID: 20967418.

    Article  PubMed  Google Scholar 

  60. Santoro GA, Wieczorek AP, Dietz HP, Mellgren A, Sultan AH, Shobeiri SA, et al. State of the art: an integrated approach to pelvic floor ultrasonography. Ultrasound Obstet Gynecol. 2011;37(4):381–96. PubMed PMID: 20814874.

    Article  CAS  PubMed  Google Scholar 

  61. Prasad SR, Menias CO, Narra VR, Middleton WD, Mukundan G, Samadi N, et al. Cross-sectional imaging of the female urethra: technique and results. Radiographics. 2005;25(3):749–61. PubMed PMID: 15888623.

    Article  PubMed  Google Scholar 

  62. Defreitas GA, Wilson TS, Zimmern PE, Forte TB. Three-dimensional ultrasonography: an objective outcome tool to assess collagen distribution in women with stress urinary incontinence. Urology. 2003;62(2):232–6. PubMed PMID: 12893325.

    Article  PubMed  Google Scholar 

  63. Santoro GA, Shobeiri SA, Scholbach J, Chlebiej M, Wieczorek AP. Technical innovations in pelvic floor ultrasonography. In: Santoro GA, Wieczorek AP, Bartram CI, editors. Pelvic floor disorders: imaging and multidisciplinary approach to management. Dordrecht: Springer; 2010. p. 103–14.

    Chapter  Google Scholar 

  64. Reddy AP, DeLancey JO, Zwica LM, Ashton-Miller JA. On-screen vector-based ultrasound assessment of vesical neck movement. Am J Obstet Gynecol. 2001;185(1):65–70. PubMed PMID: 11483906.

    Article  CAS  PubMed  Google Scholar 

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Correspondence to Magdalena Maria Wozniak M.D., Ph.D. .

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Wieczorek, A.P., Wozniak, M.M. (2014). Endovaginal Urethra and Bladder Imaging. In: Shobeiri, S. (eds) Practical Pelvic Floor Ultrasonography. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-8426-4_5

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  • DOI: https://doi.org/10.1007/978-1-4614-8426-4_5

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