ABSTRACT
The Aim of this work is to demonstrate the dynamic relationships, of the urinary bladder, urethra, urethrovesical junction, and symphysis pubis during stress and to assess the reproducibility of trans-vaginal ultrasonography [TVUS] for preoperative evaluation of stress urinary incontinence in females, together with evaluation of its diagnostic value compared to urodynamic findings. This study was conducted on 97 female patients including 71 patients with clinically diagnosed stress urinary incontinence [SUI] as group [A] for comparison with 26 patients with no urological complaints as control group [B]. All patients underwent complete history and physical examination, laboratory investigations, urodynamic evaluation especially valsalva leak point pressure [VLPP], and trans-vaginal ultrasonography [TVUS]. Patients of group [A] were further subdivided into two sub groups [GI and GII] according to the results of VLPP. GI and GII included 47 and 24 patients with VLPP above and below 60 cm H[2O] respectively. Statistical analysis of seven transvaginal ultrasonic anatomical parameters that include measurement of bladder symphysis distance [BS], rotational angle [RA], bladder neck mobility [BNM], bladder neck vertical descend [BNVD], BN funneling [BNF], BN position [BNP], and posterior urethrovesical angle [PUVA], was done in both study groups at rest and during strain together with correlation of these 7 parameters and urodynamic VLPP findings. A highly statistically significant difference was found in all the seven parameters measured by TVUS in group [A] when compared to control group B and in each patient of the two groups during both phases at rest and during strain [p <0.001]. There is a significant high positive correlation between TVUS parameters and VLPP findings. The sensitivity and specificity of TVUS in detecting SUI were 92.9% and 92.31% respectively when compared to 83.09% and 84.61% of urodynamics. Positive and negative predictive values of TVUS are 97.1%, and 82.7%, respectively. The over all accuracy of TVUS was 92.8% compared to 83.50% of urodynamics. TVUS is a simple minimally invasive endosonographic technique that provides opportunity to combine anatomic and functional views of the urinal bladder and urethra compared to other radiological method. The patients avoiding catheterization hazards, exposures to radiation, and the sophistication of multi-channel urodynamic evaluation, readily accept it. TVUS not only can be considered as a significant reliable tool for diagnosing and classifying [SUI] but also of prognostic value in predicting better successful surgical outcomes with proper choice of the surgery type according to each type of SUI. We strongly believe that TVUS is a technique that deserves to be supported for further applications