Тhе using of transvaginal ultrasound of urethrovesical segment in different types of stress incontinence diagnostics

Full Text

At present the different types of stress incontinence diagnostics and treatment are the main topics of urogy­necology. T1·aditional methods of clinical, urodynamic and endoscopic exams have been completed Ьу non­invasive 2D and 3D ultrasound.

Objective. То estimate transvaginal ultrasound val­ue in di ffeгent types of stress. incontinence diagnostics and treatment.

Materials and methods. 29 patients from 36 to 82 у.о. with stress incontinence were examined in Operative Gy­necology Department of D.O. Ott Iпstitute.

То derminate the type of stress incontinence and its se­verity the echography of urehtrovesical segment was per­forrned in аll observed women using transvaginal probe Voluson-730 expert (GE), (Chechneva М.А., 2000).

The measurements of basic angles were performed in patients in supine position at rest and on Yalsalva. The angle а was measured as an angle between proxi­mal urethra апd conventional longitudinal axis of the body. The angle р was retrovesical (or posterior ure­throvesical) angle between proximal urethra and tri­goпe on the level of the Ьladder neck. On Yalsalva, the proximal urethra may Ье seen to rotate in а posterior-in­ferior direction. Tl1e changing of angle а expressed the degree of its rotation. Also the cystocele presence were noted. When the funneling of the intemal urethral me­atus were observed the width of proximal urethra was measured with followiпg dynamic 3D reconstruction. After that the ratio of urethra transversal section square and urethral sphincter width were calculated.

Results. The mean values of a and ß angles at rest in observed patients were 3 1 ,6° и 112, 7° , accordingly. In 8 patients the ultrasound signs of urethra hypermobil­ity were found (sterss incontinence, type II) - the angle а rotation was more than 20°. In 9 women the signs of urethral sphincter insufficiency took place (stress incontinence, type III), when the ratio of urethra trans­versal section square and urethral sphincter width ex­ceeded 0,74. Tn three cases the combination of stress incontinence of both (II and III) types was revealed. Jn the rest 9 women the ultrasound signs of urethrovesical interrelation disturbances were not found.

Based оn ultrasound data 17 patients were operated. In the Ilnd type of stress incontinence the antistress sur­gery was performed (ТУТ and ТУТ-О). In the IIId type of stress incontinence the urethropexy with IYS, Gyne­Mesh and Gyne-Mesh soft plastic surgery of vaginal walls were carried out. In all patient the surgery was added Ьу the colpoperineolevatoroplastics.

Ultrasound control of urethrovesical interrelation dynamic and prolen transplantants position were per­formed in the early postoperative period (оп 3d and 10th day). The positive dynamic were registrated in аpoperated patients.

Conclusion. The using of transvaginal 2D and 3D echography in examination of patients with stress in­conti11ence gives the possibility to estimate obejctively the urethrovesical anatomy and optimise their treat­ment. At present time tl1e long-term results analysis is fulfiling.

About the authors

V. S. Prokhorova

D.O. Ott Institute of Obstetrics and Gynecology, RAMS

Author for correspondence.
Email: info@eco-vector.com
Russian Federation, Saiпt-Peteгsbttrg

V. F. Bezhenar

D.O. Ott Institute of Obstetrics and Gynecology, RAMS

Email: info@eco-vector.com
Russian Federation, Saiпt-Peteгsbttrg

N. G. Pavlova

D.O. Ott Institute of Obstetrics and Gynecology, RAMS

Email: info@eco-vector.com
Russian Federation, Saiпt-Peteгsbttrg

References

Supplementary files