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CHARACTERIZATION OF URETHRAL-BLADDER NECK IMAGING IN A GROUP OF FEMALE PATIENTS WITHOUT STRESS URINARY INCONTINENCE ON DYNAMIC PELVIC FLOOR MR
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Abstract
Purpose: To evaluate the anatomical structure of the urethra - bladder neck in female patients without stress incontinence (SUI) on pelvic floor dynamic magnetic resonance imaging (DP-MRI). Material and method: 21 female patients without stress urinary incontinence were underwent pelvic floor magnetic resonance imaging (for other reasons such as constipation, obstructive defecation syndrome, etc.) with static and dynamic pulse sequences. In static pulse sequences, we measured the anatomical structures of the urethra (length, urethral volume, striated-smooth muscle layer thickness). In dynamic pulse sequences (at rest and evacuation), we measured the bladder-urethral neck angles (eg, urethral angle, posterior urethra-vesical angle PUVA, bladder neck - pubococcygeal angle) as well as the position of the bladder neck relative to the pubo-coccygeal line -PCL (negative if above the coccyx and positive otherwise). Results: The median age of the group of patients was 63, the oldest was 80 years old, the youngest was 29 years old. Most patients (16/21) underwent pelvic floor MRI for constipation or obstructive defecation syndrome, the rest (5/21) due to urinary disorders but no SUI. On static pulse sequences, the mean urethral length and volume were 33.9 ± 6.7 mm and 7.1 ± 1.9 cm3, respectively, striated muscle thickness was 2.4 ± 0.45 mm, smooth muscle thickness was 5.4 ± 0.66 mm. On dynamic pulse sequences, the mean urethral angle, posterior urethra-vesical angle (PUVA), bladder neck - pubococcygeal angle at rest and evacuation phases were 17.2±9.1 degrees and 56.2±29.7 degrees; 123.2±13.3 degrees and 121.4±20.6 degrees; 57.8±28.2 degrees and 43.2±25.9 degrees, respectively. The position of the bladder neck relative to the pubococcygeal line at rest and evacuation phase was: (-) 17.9±7.8 mm and (+) 9.6±13.4 mm, respectively. Conclusion: Our study showed the measurement of the anatomical structures of the urethra-bladder neck in the group of female patients without SUI. These parameters were analyzed and recorded in the data table to compare and find the cause in the group of patients with SUI.
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Keywords
Dynamic pelvic floor MRI, Stress urinary incontinence, Posterior urethro vesical angle
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