HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text All Versions of this Article: 2252011347v1 225/2/433    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by deSouza, N. M. Articles by Abel, P. D. Search for Related Content PubMed PubMed Citation Articles by deSouza, N. M. Articles by Abel, P. D.

Female Urinary Genuine Stress Incontinence: Anatomic Considerations at MR Imaging of the Paravaginal Fascia and Urethra—Initial Observations¹

¹ From the Robert Steiner MRI Unit (N.M.d.S., O.J.D., A.D.W., D.J.G.) and Academic Section of Urology in the Department of Surgery (O.J.D., P.D.A.), Faculty of Medicine, Imperial College of Science, Technology and Medicine, Hammersmith Hospital Campus, DuCane Rd, London W12 0HS, England. From the 2001 RSNA scientific assembly. Received August 8, 2001; revision requested September 28; final revision received May 2, 2002; accepted May 14. Supported by Marconi Medical Systems. Address correspondence to N.M.d.S. (e-mail: n.desouza@ic.ac.uk).

PURPOSE: To compare, on high-spatial-resolution magnetic resonance (MR) images, the presence and distribution of the paravaginal fascia in continent women and in those with genuine stress incontinence (GSI) to establish its role in the pathophysiology of GSI.

MATERIALS AND METHODS: Eleven continent reference subjects and 10 GSI patients underwent MR imaging with a specifically designed endovaginal receiver coil. A urinary continence questionnaire and urogynecologic clinical examination had been completed. GSI was diagnosed with urodynamic tests. Paravaginal fascial tissue distribution was determined, and the paravaginal fascial volume (PFV) anteriorly associated with the urethra was measured. Retropubic urethral length (UL) in the supine position at rest was compared with its total length and expressed as a percentage ratio. Comparisons of urethral PFV and retropubic UL between reference subjects and the GSI patients were performed by means of two-sample t tests with unequal variances because data were parametric by means of the Shapiro-Francia W' test for normal data.

RESULTS: The paravaginal fascia (connective tissue that contained venous plexus) was a consistent MR imaging feature in all women. Mean urethral PFV was 5.3 cm³ ± 0.6 (SD) in reference subjects compared with 3.5 cm³ ± 2.0 in GSI patients (P = .017). The ratio of the retropubic UL to its total length was 82.6% ± 7.4 in reference subjects compared with 57.4% ± 9.8 in GSI patients (P < .001). There was a weak correlation between urethral PFV and retropubic UL (r = 0.46).

CONCLUSION: There is a significant association between urethral PFV and continence status. GSI patients have a reduced urethral PFV, and greater than 40% of their urethral length lies below the pubis in the supine position at rest. However, the effects of age and hormonal status on urethral PFV remain to be evaluated.

© RSNA, 2002

Index terms: Magnetic resonance (MR), intracavitary coils, 85.121411 • Pelvic organs, 85.92 • Pelvic organs, MR, 85.121411 • Urethra, 851.121411, 851.92 • Vagina, 855, 121411, 855.92

This article has been cited by other articles:

				K. J. Macura, R. R. Genadry, and D. A. Bluemke MR Imaging of the Female Urethra and Supporting Ligaments in Assessment of Urinary Incontinence: Spectrum of Abnormalities. RadioGraphics, July 1, 2006; 26(4): 1135 - 1149. [Abstract] [Full Text] [PDF]