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International Urogynecology Journal

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01-01-2016 | Original Article

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

Authors: Farah Lone, Ranee Thakar, Andrzej P. Wieczorek, Abdul H. Sultan, Aleksandra Stankiewicz

Published in: International Urogynecology Journal | Issue 1/2016

Abstract

Introduction

Urethral vascularity is responsible for organ perfusion. It is also believed to contribute to maintaining the normal tension in the urethral mucosa and contributes to approximately one third of urethral closure pressure. We hypothesised that in women undergoing treatment for stress urinary incontinence (SUI), there is no change in blood flow intensity.

Methods

In this pilot study we recruited women attending the urogynaecology clinics between July and October 2009. Exclusion criteria included symptoms of pelvic organ prolapse or urinary tract infection. Colour Doppler ultrasound was performed at the level of the mid-urethra using a high-frequency (9–12 MHz) endovaginal ultrasonography (EVUS) focusing on the following vascular parameters: flow velocity (V), area of the vessels (A), intensity of perfusion (I), Tissue Pulsatility Index (TPI) and Tissue Resistance Index (TRI). Vascular assessments were repeated at 1 year.

Results

We examined 67 women with symptoms of SUI (17 women had surgery and 50 conservative management, i.e., pelvic floor muscle exercises). The mean (± SD) age in the conservative and surgical groups was 46 (±11) and 40 (±9) years respectively and median (range) parity was 2 (0–8) in both groups. Compared to baseline, no statistically significant differences were observed within each group (p > 0.05) or between the values of vascular parameters (V, A, I, TRI and TPI) at 1 year. There was also no difference in vascular parameters between the two groups.

Conclusion

At 12 months there is no change in vascularity parameters in women who opt for conservative or surgical treatment of SUI.

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

De Lancey JOL, Ashton-Miller JA (2004) Pathophysiology of adult urinary incontinence. Gastroenterology 126:S23–S32CrossRef

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

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

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

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

Wieczorek AP, Woźniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T, Scholbach J (2011) Quantitative assessment of urethral vascularity in nulliparous females using high-frequency endovaginal ultrasonography. World J Urol 29(5):625–632PubMedCrossRef

Lone F, Sultan AH, Stankiewicz A, Thakar R, Wieczorek AP (2014) Vascularity of the urethra in continent women using color Doppler high-frequency endovaginal ultrasonography. Springerplus 3:619PubMedPubMedCentralCrossRef

Lone F, Sultan AH, Stankiewicz A, Thakar R (2014) The value of pre-operative multicompartment pelvic floor ultrasonography: a 1-year prospective study. Br J Radiol 87:2014CrossRef

10.

Santoro GA, Wieczorek AP, Stankiewicz A, Wozniak MM, Bogusiewicz M, Santoro GA, 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):1213–1222PubMedCrossRef

11.

Scholbach T, Herrero I, Scholbach J (2004) Dynamic color Doppler sonography of intestinal wall in patients with Crohn disease compared with healthy subjects. J Pediatr Gastroenterol Nutr 39(5):524–528PubMedCrossRef

12.

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 13:236–252CrossRef

13.

Van Leijsen SA, Hoogstad-van Evert JS, Mol BW, Vierhout ME, Milani AL, Heesakkers JP, Kluivers KB (2011) The correlation between clinical and urodynamic diagnosis in classifying the type of urinary incontinence in women. A systematic review of the literature. Neurourol Urodyn 30(4):495–502PubMedCrossRef

14.

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):99–104CrossRef

15.

Kohorn EI, Scioscia AL, Jeanty P, Hobbins JC (1986) Ultrasound cystourethrography by perineal scanning for the assessment of female stress urinary incontinence. Obstet Gynecol 68:269–272PubMed

16.

Schaer GN, Koechli OR, Schuessler B, Haller U (1995) Perineal ultrasound for evaluating the bladder neck in stress incontinence. Obstet Gynecol 85:220–224PubMedCrossRef

17.

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

18.

Siracusano S, Bertolotto M, Silvertre G, d’Aloia G, Pecorari V, Stener S, Quaia E, Baschiera P, Knez R (2002) The feasibility of urethral color ultrasound imaging in the diagnosis of female intrinsic sphincter deficiency: preliminary results. Spinal Cord 40:192–5PubMedCrossRef

19.

Siracusano S, Bertolotto M, Cucchi A et al (2006) Application of ultrasound contrast agents for the catheterization of female urethral vascularization in healthy pre- and postmenopausal volunteers: preliminary report. Eur Urol 50:1316–1322PubMedCrossRef

20.

Tublin ME, Bude RO, Platt JF (2003) The resistance index in renal Doppler sonography: where do we stand? Am J Roentgenol 180(4):885–892CrossRef

21.

Terslev L, Torp-Pedersen S, Qvistgaard E, Bliddal H (2003) Spectral Doppler and resistive index: a promising tool in ultrasonographic evaluation of inflammation in rheumatoid arthritis. Acta Radiol 44(6):645–652PubMed

22.

Govind BC, Dimitri AP, Andrea M, Oscar MN (2008) Normal Doppler spectral waveforms of major pediatric vessels: specific patterns. Radiographics 28:691–706CrossRef

23.

Raine-Fenning NJ, Campbell BK, Clewes JS, Kendall NR, Johnson IR (2003) The reliability of virtual organ computer-aided analysis (VOCAL) for the semiquantification of ovarian, endometrial and sub endometrial perfusion. Ultrasound Obstet Gynecol 22(6):633–639PubMedCrossRef

24.

Basgul A, Kavak ZN, Bakirci N, Gokaslan H (2007) Three-dimensional ultrasound power Doppler assessment of the cervix: comparison between nulliparas and multiparas. J Perinat Med 35(1):48–50PubMed

25.

Jones NW, Raine-Fenning NJ, Mousa HA, Bradley E, Bugg GJ (2011) Evaluating the intra and interobserver reliability of three-dimensional ultrasound and power Doppler angiography (3D-PDA) for assessment of placental volume and vascularity in the second trimester of pregnancy. Ultrasound Med Biol 37(3):376–385PubMedCrossRef

26.

Wieczorek AP, Wozniak MM, Stankiewicz A, Santoro GA, Bogusiewicz M, Rechberger T (2012) 3-D high-frequency endovaginal ultrasound of female urethral complex and assessment of interobserver reliability. Eur J Radiol 81(1):e7–e12PubMedCrossRef

27.

28.

Gagel B, Piroth M, Pinkawa M et al (2007) pO2 polarography, contrast enhanced Color Duplex Sonography (CDS), [18F] fluoromisonidazole and [18F] fluorodeoxyglucose positron emission tomography: validated methods for the evaluation of therapy-relevant tumour oxygenation or only bricks in the puzzle of tumour hypoxia? BMC Cancer 28(7):113CrossRef

29.

Liu CM, Tsai EM, Hsu SC, Wu CH, Wang CL, Long C (2008) Effect of laparoscopic hysterectomy on the vascularization of the lower urinary tract. Urol Int 80(1):62–67PubMedCrossRef

30.

Caruso S, Rugolo S, Bandiera S, Mirabella D, Cavallaro A, Cianci A (2007) Clitoral blood flow changes after surgery for stress urinary incontinence: pilot study on TVT versus TOT procedures. Urology 70(3):554–557PubMedCrossRef

Title: Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study
Authors: Farah Lone
Ranee Thakar
Andrzej P. Wieczorek
Abdul H. Sultan
Aleksandra Stankiewicz
Publication date: 01-01-2016
Publisher: Springer London
Published in: International Urogynecology Journal / Issue 1/2016
Print ISSN: 0937-3462
Electronic ISSN: 1433-3023
DOI: https://doi.org/10.1007/s00192-015-2800-z

At a glance: The STEP trials

Springer Medicine

Assessment of urethral vascularity using 2D colour Doppler high-frequency endovaginal ultrasonography in women treated for symptomatic stress urinary incontinence: 1-year prospective follow-up study

Abstract

Introduction

Methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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