Perianal ultrasound (PAUS): visualization of sphincter muscles and comparison with digital-rectal examination (DRE) in females.

BACKGROUND: The aim of this study was to determine the reproducibility and tolerance of perianal ultrasound (PAUS) and detect differences in sphincter muscles between various measuring positions and different maneuvers. PAUS was compared to digital-rectal examination (DRE) to see if sphincter contraction is visible and gradable in ultrasound volumes. METHODS: Fifty women underwent a medical history, DRU and PAUS by two uro-gynecologists in a prospective trial. PAUS volumes were measured via different parameters in different maneuvers. Examiners' DRE impressions of sphincter tone were scaled with the DRESS-score. All patients completed a questionnaire. RESULTS: Thirty-five patients with complete PAUS and DRE were included in the study. Fifteen patients were excluded due to poor ultrasound volume quality or sphincter defects. Comparison of sphincter muscle thickness at different positions in PAUS showed significant differences between 6 and 12 o'clock positions (12 > 6 o'clock) and diameters (horizontal > vertical). No difference was found between the examiners. In comparison of rest and contraction only the vertical diameter changed. There was a negative but not significant correlation between PAUS measurements and DRESS-scores. Twenty-six patients completed the questionnaire that revealed women preferred PAUS over DRE. CONCLUSION: PAUS is a reproducible and good tool to visualize the anal canal. It is comfortable for patients and easily handled by examiners. Sphincter muscle contraction is iso-volumetric. Vertical diameter changes during contraction leading the anal canal change its shape to oval due to external influence. PAUS is the ideal additional tool to visualize relevant structures that are palpable on DRE.

Size Does Not Make the Difference: 3D/4D Transperineal Sonographic Measurements of the Female Urethra in the Assessment of Urinary Incontinence Subtypes.

Purpose. The objective was to evaluate the usefulness of transperineal ultrasound in the assessment of the urethral length and urethral lumen by 3D/4D transperineal sonography to discriminate between female patients with subtypes of urinary incontinence. Methods. A total of 150 female patients underwent an examination because of urinary incontinence. 41 patients were diagnosed with urgency urinary incontinence (OAB), 67 patients were diagnosed with stress urinary incontinence (SUI), and 42 patients were in the control group (CTRL). Three diameters of the urethral lumen (proximal (U1), medial (U2), and distal (U3)) and the urethral length were measured. By the assessment of the urethral lumen, the presence of the urethral funneling was evaluated. Results. We found a significant difference in the urethral length and urethral lumen U2 of OAB and SUI versus CTRL. The urethral length was significantly greater (P < 0.05) and the urethral lumen was significantly wider (P < 0.05) in the patients with urinary incontinence. The incidence of the urethral funneling was significantly higher (P < 0.05) in the study groups with urinary incontinence than in the control group. Conclusions. Our results have shown the urethral changes obtained by ultrasound in patients with urinary incontinence, but they are still insufficient to distinguish between subtypes of urinary incontinence.

Tomographic Ultrasound Imaging to Control the Placement of Tension-Free Transobturator Tape in Female Urinary Stress Incontinence.

Purpose. The objective was to evaluate, by means of tomographic ultrasound imaging (TUI), the reliability of a novel approach for determining the position of the implanted tension-free transobturator tape (TOT). Furthermore, we analyzed the association between the position of the tape at rest and the subjective cure in stress incontinent women. Methods. This retrospective pilot study consists of 32 stress incontinent women, who underwent TOT procedure and routine sonographic control at day 1 postoperatively and at follow-up visit. TUI was applied on the resulting 4D volumes, thereby delivering 9 axial slices with a 4 mm interslice distance starting at the meatus urethrae internus in caudal direction. The reliability of the approach was tested by two examiners. Postoperative and follow-up ultrasound parameters of uncured and cured patients were analyzed. Results. Measurements of the position of the TOT demonstrated high intraclass correlation coefficients. We found minor differences between sonographic parameters at day 1 postoperatively and at follow-up after a median period of 321 days. In cured patients, the position of the tape was measured in a more caudal position than in uncured patients. Conclusions. TUI can be a reliable method for determining the position of the tape. Further studies are needed to evaluate whether the postoperatively determined position can be used as an indicator of future subjective cure.

Nucleated red blood cells as marker for an increased risk of unfavorable outcome and mortality in very low birth weight infants.

BACKGROUND: Nucleated red blood cells (NRBC) are normoblastic cells that failed to extrude their nuclei before exiting from bone marrow or liver. While NRBC are frequently found in umbilical cord blood after fetal distress, NRBC counts drop rapidly after birth. AIMS: To determine the predictive value of the NRBC count during the first 120h after birth as marker for later risk of unfavorable outcome in very preterm infants. STUDY DESIGN: This cohort study investigated the association between absolute count of NRBC on admission (day 1), the mean NRBC count between day 2 to 5, and outcome (mortality or the composite outcome of mortality and severe morbidity). RESULTS: 438 infants with a gestational age<32weeks and a birth weight<1500g were included within a five-year period, of whom 46 patients died and 65 suffered from severe morbidity. Nonsurvivors had significantly higher NRBC counts between day 2 and 5, as compared to survivors. This finding was observed in infants both appropriate and small for gestational age. An increase of 10/nL of the mean NRBC count on postnatal day 2 to 5 had an odds ratio for mortality of 6.95 (95% CI 2.21-21.86) and an odds ratio for the composite outcome mortality and severe morbidity of 3.43 (95% CI 1.43-8.24). The optimal cut-off value for prediction of death was NRBC >2/nL with a sensitivity of 85% and a specificity of 75%. CONCLUSIONS: Elevation of NRBC on postnatal day 2 to 5 is an independent predictor of mortality in preterm infants.