Bladder neck evaluation by perineal ultrasound before and after reconstructive surgery for pelvic organ prolapse.
OBJECTIVE
To study the correlation between stress urinary incontinence (SUI) and the mobility and funneling of the bladder neck (BN) by observation of pre- and postoperative course by perineal ultrasound (PUS).


METHODS
We investigated 123 cases that underwent reconstructive surgery for pelvic organ prolapse (POP). We prospectively checked bladder neck mobility (BNM) during the Valsalva maneuver and funneling of the BN at rest by PUS. We defined the width multiplied by the depth of the funnel-like profile of the BN as the funneling index (FI). We checked BNM, FI, and the presence of SUI just before the operation, and we checked the postoperative course of BNM and SUI.


RESULTS
When BNM was ≥10 mm before surgery, the odds ratio for accompanying SUI was 2.68 relative to BNM <10 mm (p = 0.031). When FI was ≥150 before surgery, the odds ratio for accompanying SUI was 4.12 relative to FI <150 (p = 0.004). Although postoperative BNM values were significantly improved immediately after surgery, they gradually increased within 2 years. Among the cases with preoperative SUI, the recurrence rate was significantly higher in the patients whose FI was <150 (p = 0.019).


CONCLUSIONS
Our results yielded by PUS suggested that larger BNM and FI values were the causative factors of SUI. PUS may be beneficial for selecting a suitable surgical procedure for POP, and it may also be helpful for assessing surgical efficacy.
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan. manabun@f2.dion.ne.jp.
Manabu
M
Nishibayashi
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
Koichi
K
Kobayashi
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
Akinori
A
Miki
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
Ryugo
R
Okagaki
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
Ichiro
I
Nagata
Jikei Clinical Research and Development, Jikei University School of Medicine, Tokyo, Japan.
Mitsuyoshi
M
Urashima
Department of OB/GYN, Saitama Medical University, 38, Morohongo, Moroyama, Iruma, Saitama, 350-0495, Japan.
Osamu
O
Ishihara
Bladder neck mobility; Funneling index; Pelvic organ prolapse; Perineal ultrasound; Stress urinary incontinence