Comparison of cystographic findings of intrinsic sphincteric deficiency with urethral hypermobility causing urinary incontinence.

OBJECTIVES

To evaluate the usefulness of standing and lateral cystograms for differentiation of intrinsic sphincter deficiency (ISD) from urethral hypermobility (UH) causing stress urinary incontinence (SUI).

MATERIALS AND METHODS

67 female patients with urinary incontinence undergoing measurement of the Valsalva leak point pressure (VLPP) were included. 14 patients with VLPP <60 cm H2O were operated for ISD causing SUI while 53 patients with VLPP >100 cm H2O were operated for UH causing SUI. Three radiologists compared the cystographic findings.

RESULTS

The changes in posterior urethrovesical angle (PUVA) between stress and resting states were 12 +/- 7.5 degrees in ISD causing SUI and 32.8 +/- 12.7 degrees in UH causing SUI, and showed a statistically significant difference (p < 0.01). The beaking signs of the vesical neck on anteroposterior (AP) projection of the cystogram during a resting state were seen in 76% of ISD causing SUI. The difference was also statistically significant (p < 0.01). The existence of cystocele or the mean PUVA in two groups did not show a statistically significant difference.

CONCLUSION

ISD should be considered in female patients with symptoms of urinary incontinence where there are changes in PUVA <20 degrees on a lateral cystogram between a stress state and resting state in addition to the beaking sign of the vesical neck during a resting state.