Korean J Urol.  2011 Oct;52(10):687-692. 10.4111/kju.2011.52.10.687.

Relationship between Proximal Urethrovaginal Space Thickness and Detrusor Overactivity in Women with Stress Urinary Incontinence

• Chae JY
• Kim JH
• Bae JH
• Lee JG

• KMID: 2061431
• DOI: http://doi.org/10.4111/kju.2011.52.10.687

Abstract

PURPOSE
Detrusor overactivity (DO) cannot be predicted by clinical symptoms. Although it is possible that DO could be related to anatomical structures, scanty data exist about the relations between DO and anatomical structures. The aim of this study was to investigate anatomical differences in DO by measuring the thickness of the urethrovaginal space (UVS) and the urethral length (UL) in women with stress urinary incontinence (SUI).
MATERIALS AND METHODS
Prospective data were collected from 72 women with SUI who underwent the midurethral sling operation. The subjects were divided into 2 groups according to the presence of DO by preoperative urodynamic study (UDS). UVS thickness was measured by trans-vaginal ultrasound. UL was measured by using a urethral catheter and a ruler. UVS thickness, UL, Q-tip, and urodynamic parameters, such as maximal urethral closure pressure (MUCP) and Valsalva leak point pressure, were compared between the two groups.
RESULTS
Of 72 women, 23 patients had DO (31.9%). The proximal UVS was significantly thinner (p<0.001) and the MUCP was significantly lower (p=0.008) in women with DO. According to the receiver operating characteristic (ROC) curve based DO prediction, the best cutoff value for UVS thickness was 0.84 cm (area under the ROC curve 0.763).
CONCLUSIONS
In this study, the proximal UVS was significantly thinner and the MUCP was significantly lower in patients with DO. A proximal UVS thickness of less than 0.84 cm was shown to be a predictive parameter for the development of DO on preoperative UDS. A large-scale prospective study is needed to validate these results.

Keyword

Urinary incontinence; Urodynamics

MeSH Terms

Female
Humans
Prospective Studies
ROC Curve
Suburethral Slings
Urinary Catheters
Urinary Incontinence
Urodynamics

Figure

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  FIG. 1 Measurement of proximal urethrovaginal space by transvaginal ultrasonography (the arrow represents the distance between the anterior vaginal wall and the catheter balloon).

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  FIG. 2 Measurement of urethral length by use of a Foley catheter (the mark on the catheter represents the point of the urethral meatus and the proximal end of the balloon represents the point of the bladder neck, respectively).

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  FIG. 3 Receiver operating characteristic (ROC) curve of urethral length (UL), proximal urethrovaginal space (UVS), and maximal urethral closure pressure (MUCP) for detrusor overactivity (AUC: 0.567, 0.763, and 0.694, respectively).

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