Donovan J M, Gleason D M
Department of Surgery, University of Arizona, Tucson.
Urology. 1990 May;35(5):458-63. doi: 10.1016/0090-4295(90)80095-5.
The most specific radiographic findings characterizing stress incontinence (SI) on upright retrograde urethrocystography include replacement of a flat or rounded bladder base with a concave funnelled base; patency of the bladder neck with contrast material pooling in the proximal urethra; the descent of the intravesical Foley balloon beyond the internal meatus and into the proximal urethra. We found that neither a cystocele nor the dependent position of the urethra at the bottom of the bladder were diagnostic of SI if the above stigmata were absent. On the other hand the defect of urgency incontinence (UI) is functional. The bladder can usually be filled by retrograde urethral infusion (though in severe UI this may not be the case). An alert technician can frequently obtain a film when the patient is experiencing uninhibited voiding. The finding of contrast material throughout the urethra, in the distal urethra alone, or in the parameatal area is strongly suspicious for UI, especially when trabeculation is also seen. These findings in association with the stigmata of SI give warning of combined SI and UI.
立位逆行尿道膀胱造影中，压力性尿失禁（SI）最具特异性的影像学表现包括：膀胱底部由平坦或圆形变为漏斗状凹陷；膀胱颈开放，造影剂在近端尿道积聚；膀胱内Foley球囊降至尿道内口以外并进入近端尿道。我们发现，如果没有上述特征，膀胱膨出或尿道位于膀胱底部的下垂位置均不能诊断为SI。另一方面，急迫性尿失禁（UI）的缺陷是功能性的。膀胱通常可通过逆行尿道灌注充盈（尽管在严重的UI中可能并非如此）。警觉的技术人员通常可以在患者出现无抑制性排尿时获得影像。尿道全程、仅远端尿道或尿道口旁区域出现造影剂强烈提示UI，尤其是同时伴有小梁形成时。这些表现与SI的特征相结合提示合并存在SI和UI。
