DIAGNOSTIC POSSIBILITIES OF ULTRASONOGRAPHY IN THE DIAGNOSIS OF STRESS URINARY INCONTINENCE IN WOMEN

Purpose: The aim of our study was to compare the availability and amount of information obtained from X-ray diagnosis as opposed to ultrasonography in the diagnosis of stress urinary incontinence in women. Methods and Materials: The case notes of 73 female patients, who received treatment for incontinence of urine, were studied. All patients underwent urethrocystography in the antero-posterior (A/P) and lateral projections. They also had ultrasonographic assessment of the upper and lower urinary tract as well as the internal genital organs. The patients were examined in the lithotomy position with standard filling of the bladder. We performed transabdominal, perineal and transvaginal scans. Results: 24 patients (32.86%) had pelvic prolaps. In 5 of them (6.84%) the cervix was lying above the pubis at rest, 16 patients (21.91%) had the cervix located 1cm below the level of the pubic symphisis, 31 (42.46%) –1–2cm below the pubis, and 32 (43. 82%) – greater than 2cm below the pubis. 23 (3.5%) had an incompetent bladder neck with stress. In 9 (12.32%) patients the funnel shape of the bladder neck was retained at rest. Shortening of the urethra was observed in 41 (56.1%) patients during the Valsalva maneuver. Widening of the proximal urethra was seen in 5 (6.84%) of the patients. In 17 patients (23.28%), we observed atrophy of the pelvic floor muscles. Similar results were obtained during X-ray urethrocystography. In addition to the obtained results, we observed co-morbid conditions of the upper urinary tract in 6 (8.21%) patients. 3 patients (4.1%) had dilatation of Pelvicaliceal System and hyperechogenic inclusions with „acoustic shadow“. Excretory urography was carried out following those findings. Co-morbid conditions of the internal genital organs (uterine fibroids, ovarian cysts, varicose veins of the true pelvis etc) were seen in 32 patients (43.83%). The physiologic capacity of the bladder was determined in all the patients. In the majority of cases (54.87%) this ranged from 200–350ml. 6 patients (8.12%) had incomplete emptying of the bladder. There was no space occupying lesion nor stones in the bladder. Conclusions: Ultrasonography is not less informative then urethrocystography as a method of investigating patients with incontinence. Sometimes it is superior to urethrocystography and allows us not only to determine the shape and position of the bladder, but also to measure the thickness of its wall, as well as assess the macroscopic structure of the t