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THE ROLE OF DYNAMIC PELVIC FLOOR MAGNETIC RESONANCE IMAGING IN THE DIAGNOSIS OF STRESS URINARY INCONTINENCE IN FEMALE PATIENTS
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Abstract
Purpose: To evaluate the role of dynamic pelvic floor magnetic resonance imaging (MRI) in diagnosing the cause of stress urinary incontinence (SUI) in female patients. Material and method: This prospective study was carried out on 43 female patients, including 22 patients with SUI (disease group) and 21 patients without SUI (control group), all underwent the dynamic pelvic floor MRI. Urethral angle (UA), posterior urethro-vesical angle (PUVA), bladder neck – pubo-coccygeal angle (BNPCA), and position of bladder neck (BN) and cervix relative to the pubococcygeal line (PCL) were measured on dynamic (Cine) pulse sequences at rest and evacuation phases. These parameters were compared between two groups to evaluate which anatomical factors affecting on SUI. Results: The mean age of the patients was 57.3±13.8 y.o (disease group: 53.9±12.6, control group: 60.8±14.4), the mean number of childbirths was 2.2±0.65, the vaginal delivery accounted for 73% in each group. There was no statistically significant difference (p>0.05) between the two groups in terms of the urethral angle, bladder neck-pubo-coccygeal angle, position of bladder neck relative to pubococcygeal line in both resting and evacuation phases. In contrast, there was a statistically significant difference between the 2 groups in the posterior urethro-vesical angle (p<0.001) at both rest and evacuation phases and the cervix position at evacuation phase (p=0.001). AUC of the posterior urethro-vesical angle for the SUI diagnosis was 0.9 at rest and 0.98 at evacuation phases. For the threshold 133.50 at rest phase and 153.50 at evacuation phase, the sensibility and specificity of PUVA were 0.86 and 0.86 at rest phase, and 0.91 and 0.95 at evacuation phase, respectively. Conclusion: Our study showed that the posterior urethro-vesical angle at both rest and evacuation phases provided the high sensibility and specificity for the SUI diagnosis.
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Keywords
Dynamic pelvic floor MRI, Stress urinary incontinence, Posterior urethra-vesical angle.
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