TRANSABDOMIBAL VS TRANSLABIAL ULTRASOUND FOR DIAGNOSIS AND SCREENING OF BLADDER NECK MOBILITY
Bubnov R.V., Goncharenko V.M.
Clinical Hospital ”Pheophania“ of State Affairs Department, Kyiv, Ukraine
Keywords: bladder neck mobility, pelvic pain, urine incontinence, ultrasound.
Bladder neck mobility evokes pelvic floor dysfunction, cause pain, urinary incontinence, being a widespread problem, requires about 200,000 operations annually in USA . Myofascial pelvic pain is detected in 10% to 15% of all gynecological patients. The risk of surgery for prolapse or during the lifetime is about 11-19%, increased with age, in overweight, after birthgiving, hysterectomy, etc. Tension-free vaginal tape (TVT) procedure is relevant method for treatment [1,2]. Development of valid screening method is highly recommended, because many women are silent about their problem, thus real risk of pelvic floor dysfunction is significantly higher. Ultrasound has strong potential for diagnosis of pelvic floor disorders and treatment of pelvic muscles dysfunction [3,4], however many methodologic differences and limitations still exist that induce confounders in the studies.
The aim was to assess capabilities of transabdomibal ultrasound for screening of bladder neck mobility.
Materials and methods.
We included consecutive 40 patients, females (48–76 years, 62±8 years old), assessed into the following: group 1 (n = 20) – patients suffering from pelvic floor dysfunction, pelvic pain with different location, urinary incontinence. Patients of group 2 (n = 20) had no pelvic symptoms. All patients underwent general gynecological examination, 0-21 scoring ICIQ (Incontinence Questionnaire), translabial and tranabdominal ultrasound for evaluation bladder neck mobility. For translabial ultrasound transducer was placed against the symphysis pubis, the position of the bladder neck was determined relative to the inferoposterior margin of the symphysis pubis . Measurements were taken at rest and on maximal Valsalva, and the difference yields a numerical value for bladder neck descent. Transabdominal ultrasound measurements of bladder neck rotation in a posteroinferior direction at rest and on maximal Valsalva was performed to all patients. Additionally all patients were assessed for myofascial trigger points in pelvic and low back muscles physically and on US.
The mean ICIQ score was 16.7 ± 3.4 in group 1, and 1.4 ± 0.4 in group 2. On translabial ultrasound the proximal urethra was seen to rotate in a posteroinferior direction and was measured as 45±4.3 mm (35-55 mm) in group 1 vs 23±2.4 mm (16-35 mm) in group 2 (p <0.05). On transabdominal ultrasound on maximal Valsalva, the proximal urethra was seen to rotate in a posteroinferior direction and was measured as 87± 8.7 mm (55-130 mm) in group 1 vs 42± 5.2 mm (18-50 mm) in group 2 (p <0.01). In 6 patients of group 1 we found anterior vaginal wall compartment prolapse (“cystocele”).
Transabdominal ultrasound data had correlation with symptoms (ICIQ Incontinence Questionnaire) (r=0.1801) and with translabial ultrasound (r=0.173).
In 18 patients of group 1 and in 8 patients of group 2 the myofascial trigger points in pelvic muscles were diagnosed.
Patients were considered for personalized treatment as follows: (TVT) procedure, radical or plastic surgery, either for myofacial pain treatment .
Transabdomibal ultrasound assessment of bladder neck mobility has similar correlation with urinary incontinence symptoms as translabial ultrasound, and being more simple and accessible procedure may be suggested for screening programs of bladder neck mobility. Correlation between bladder neck mobility and trigger points in pelvic muscles was revealed.
Relevant US imaging techniques for assessment interaction of internal genitalia with pelvic floor muscles, resulting bladder neck hypermobility and evoking urogenital symptoms by validated questionaires conjoin with specific gynaecological background analysis are essential for personalized management of pelvic floor dysfunction.
Disclosure: these results were presented at the ISMUS congress in Szeged, Hungary in 2014 .
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