[Ultrasonic imaging of the lower urinary tract in women with urinary stress incontinence and in women after the Burch colpopexy].

The prevalence of urinary incontinence varies from 5% in young to 50% in elderly women. The weak anatomical support of the urethrovesical junction, base of the urinary bladder and proximal urethra lead to its prolapse and hypermobility which is considered the main anatomical basis of stress incontinence. The majority of surgical procedures which resolve this problem describes elevation of the cervix of the urinary bladder. The final step of these operations, i.e. how much the urethrovesical junction should be pulled up, is described only rarely and superficially. The clinical consequence which may develop are complications associated with hypercorrection of the posterior urethrovesicular angle, i.e. problems with micturition-difficult micturition, or stage-wise micturition and symptoms of detrusor instability. The objective of the present investigation was: to analyze ultrasonic parameters of the lower urinary tract in women with stress incontinence (GSU), furthermore in women after colpopexy by Burch's method, and with regard to these results, possibly modify the surgical procedure. In the investigation in the first group 30 women were enlisted with confirmed stress incontinence. The second group was formed by 30 women three to nine months after colpopexy. The ultrasound examination was made by the perineal and introital route with the patient in a supine position, using a Acuson 128 XP 10 apparatus with a convex probe with a frequency of 5 MHz and by means of as vaginal probe with a frequency of 7.0 MHz. Assessment of the site and mobility of the urethrovesical junction was made by the transperineal route by means of a convex probe with a 300 ml filling of the urinary bladder; after micturition assessment of the areas of the urethral sphincter in a vertical and horizontal plane followed. In the vertical plane and anterior surface of the sphincter also the blood flow was measured and the pulsatile index (PI) and resistance index (RI) were assessed. The authors investigated also the thickness of the pelvic floor muscles and in the vertical plane the thickness of the urinary bladder wall on the anterior wall, in the vertex and in the area of the trigon. The authors found significant differences in ultrasound parameters in groups of women with GSI and women after colpopexy as regards the site and mobility of the urethrovesical junction and thickness of the urinary bladder wall (p < 0.01). In women with symptoms of urgency after colpopexy the authors found a mean thickness of the urinary bladder wall of more than 5 mm and mean values of the gamma angle smaller than 40 degrees and they recorded also a reduced mobility of the urethrovesical junction. These findings confirmed their expectations that in women with persisting symptoms of urgency frequently slight hypercorrection of the position of the urethrovesical junction is involved. These findings are important for the correction of the surgical approach and the evaluation of the above mentioned parameters is helpful in the diagnosis of urgency.