Intra-abdominal pressure measurement during ultrasound assessment of women with stress urinary incontinence: a novel model.
OBJECTIVE
To determine the influence of intra-abdominal pressure on the ultrasonographic evaluation of the urethrovesical junction (UVJ) and proximal urethra (PU) in women with stress urinary incontinence (SUI).


METHODS
This is a prospective cross-sectional study undertaken at the Urinary Incontinence Research Unit (UIRU) of the Universidade Federal de Pernambuco (UFPE). Thirty-six women complaining of SUI underwent perineal ultrasound assessments of the UVJ and PU having the bladder barely empty (< 50 ml of urine) with simultaneous measurement of the intra-abdominal pressure (IAP). An ALOKA ultrasound machine with a 7 MHz vaginal probe was used for the assessments. In order to measure the IAP, an Uromaster MPX616 urodynamic equipment, connected to a 10Fr rectal catheter with a pressure sensitive balloon, was used.


RESULTS
The participants' mean age was 46.4 +/- 10.2 years. On maximum straining, the mean IAP was 99.3 +/- 51.8 cm H(2)0, varying from 7 to 193 cm H(2)0, and the median was 99.5 cm H(2)0. Twenty-eight of 31 patients with UVJ hypermobility (90.3%) easily showed it with an IAP over 40 cm H(2)0. There was no significant association between the mean IAP measurements on maximum straining and the parameters studied. The IAP did induce a significant elongation of the proximal urethra length over 14 mm up to a cut-off over 80 cm H(2)O, most likely to increase urethral resistance and pressure profile, thus avoiding urine leakage. However, all 19 women with such a characteristic already presented so with an IAP > 40 cm H(2)O.


CONCLUSIONS
There is no need to measure IAP routinely on perineal ultrasound assessments of the UVJ and PU in women with SUI having a barely empty bladder.
Brandt
Frederico Teixeira
FT
Urinary Incontinence Research Unit, Federal University of Pernambuco, Av. 17 de Agosto, 2475/2801, 52060-590 Recife, PE, Brazil. fcbrandt@elogica.com.br
Lorenzato
Felipe Rinald Barbosa
FR
Nóbrega
Leonor Viana
LV
Albuquerque
Carla Daisy Costa
CD
Falcão
Rosângela
R
Araújo Júnior
Abelardo Alves de
AA
D000005:Abdomen / Q000000981:diagnostic imaging* / Q000503:physiopathology; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008875:Middle Aged; D011312:Pressure; D011446:Prospective Studies; D014463:Ultrasonography; D014521:Urethra / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001743:Urinary Bladder / Q000503:physiopathology; D014550:Urinary Incontinence, Stress / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014563:Urodynamics / Q000502:physiology; D014636:Valsalva Maneuver / Q000502:physiology*