Radiography, sonography, and magnetic resonance imaging for stress incontinence. Contributions, uses, and limitations.
Imaging has increased our ability to understand stress incontinence and prolapse and has advanced our existing concepts of pathophysiology. Once these conceptual contributions have been made, imaging modalities may fade from current use, but the lessons learned will remain. It is the relationship of clinical imaging to conceptual development that is important. Conventional radiographic studies are well understood and can be obtained in most facilities. Sonographic units are currently available in many urologic and gynecologic clinics and offices and can be adapted for stress incontinence studies. The benefits of real-time studies and soft-tissue detail at the urethrovesical junction and office-based convenience make this an attractive new technique. The global pelvic approach offered by MR imaging offers spectacular imaging possibilities, which can help in complex cases and in future concepts in the field. MR imaging is rapidly evolving and may continue to offer new insights as technology permits. In accordance with Hodgkinson's earlier observations, imaging should not be routinely required in all patients undergoing evaluation for stress incontinence, but should certainly be considered in failed operations, complex prolapse, and when clinical diagnosis is in doubt. It is always better to use an imaging technique, no matter how expensive, than to end up with a bad surgical result.
Mostwin
J L
JL
Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
Yang
A
A
Sanders
R
R
Genadry
R
R
D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D011859:Radiography; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging; D001743:Urinary Bladder / Q000000981:diagnostic imaging; D014550:Urinary Incontinence, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging; D014563:Urodynamics