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Échographie périnéale selon Dietz. La symphyse pubienne (SP), la vessie (Ve), l'urètre (U), le vagin (Va), le rectum (R) et l'utérus (Ut) sont individualisés.
Source publication
Transvaginal ultrasound is the first line imaging investigation in gynaecology. It was thus introduced for the exploration of female stress urinary incontinence at the beginning of the 1980s. Various techniques and parameters of ultrasound examination have been used for the assessment of bladder neck mobility. The aim of this literature review was...
Context in source publication
Context 1
... [3] préconise une orientation identique à celle de l'échographie endovaginale, représentant les éléments supérieurs vers le bas, les éléments dorsaux à droite et les éléments ventraux à gauche (Fig. 2). Une simple rotation de l'image de 1808 permet d'utiliser la représentation maîtrisée par ...
Citations
... [22, [95][96][97][98]. This bladder neck descent can be easily measured in 2D transperineal ultrasound by comparing the distance between the pubic symphysis and the bladder neck at rest and then during Valsalva maneuver, the difference between the two measures is reported as the bladder neck descent [99]. pregnancy. ...
Obstetric perineal tears occurring at childbirth are negative outcomes that strongly impact women’s health (pain, incontinence, sexuality). We hypothesized that considering the intrinsic elastic properties of women’s pelvic floor muscles would optimize the efficiency of existing predictive strategies. However, there was no validated method allowing an in vivo, quantitative and non-invasive assessment of these elastic properties. We considered the technology of shear wave elastography allowing an in vivo assessment of a muscle’s elastic properties and applied it, for the first time, to the study of pelvic floor muscles. Therefore, we reported that it is feasible to measure the elastic properties of the levator ani muscle and the external anal sphincter muscle and that these assessments were reliable. Then, we used this technology into a longitudinal study investigating any change in the elastic properties of women’s pelvic floor muscles through pregnancy. We failed to report any significant changes in these muscles elastic properties during pregnancy. We reported that women suffering from any perineal tear at childbirth had a less stiff external anal sphincter during late pregnancy than those having an intact perineum at childbirth. This result is in accordance with our initial hypothesis and support the implementation of upcoming larger studies in this thematic.
... Transperineal ultrasound appears to be an appropriate approach for assessing pelvic floor contraction and urethral mobility. This technique generates a panoramic view of the pelvic organs without modifying the anatomical relationship between structures and facilitates probe stability during a cough or a Valsalva maneuver [51]. ...
Introduction and hypothesis:
Assessment of pelvic floor muscle (PFM) contraction and bladder neck (BN) mobility in women with stress urinary incontinence (SUI) is essentially clinical. Ultrasound is increasingly used as a method for evaluating BN mobility and PFM contraction, but has not been standardized. The aim of this study was to review ultrasound technics and parameters that might be relevant for PFM contraction and BN mobility assessment in women with urinary incontinence (UI).
Methods:
We reviewed articles indexed in the MEDLINE database between 1988 and 2018 and selected articles which had a cohort of women with UI who had undergone functional 2D-ultrasound evaluation of PFM or BN mobility.
Results:
Transperineal ultrasound provides a panoramic view of the pelvic organs without modifying the anatomical relationship between the urethra and surrounding structural landmarks. One of the measurements used to assess urethral mobility is bladder neck descent (BND), which has been shown to be extremely reliable. Measuring the anteroposterior diameter (APD) of the urogenital levator hiatus can also reliably quantify PFM contraction in women. The more recently developed technique of elastography could be an additional useful non-invasive method for measuring periurethral striated muscle stiffness.
Conclusions:
Several ultrasound parameters such as BND, anorectal angle displacement and periurethral stiffness as measured by elastography are relevant for investigating UI in women undertaking pelvic floor muscle training. Our hypothesis is that these ultrasound parameters can be correlated with urinary symptoms and clinical contraction assessment. They need to be validated for clinical use.
... As urinary incontinence is often associated with a genital prolapse [14], we assume that insufficiency of the urethral tissue itself may be the reason for the longer anatomical urethral length. Up until now, there have been quite a few reports about the association of urethral hypermobility with urinary incontinence [15,16]. However, there is hardly any literature about a possible association between urethral elongation and urinary incontinence. ...
Objectives . To detect the anatomical insufficiency of the urethra and to propose perineal ultrasound as a useful, noninvasive tool for the evaluation of incontinence, we compared the anatomical length of the urethra with the urodynamic functional urethral length. We also compared the urethral length between continent and incontinent females. Methods . 149 female patients were enrolled and divided into four groups (stress, urge, or mixed incontinence; control). Sonographically measured urethral length (SUL) and urodynamic functional urethral length (FUL) were analyzed statistically. Standardized and internationally validated incontinence questionnaire ICIQ-SF results were compared between each patient group. Results . Perineal SUL was significantly longer in incontinent compared to continent patients ( p<0.0001 ). Pairwise comparison of each incontinent type (stress, urge, or mixed incontinence) with the control group showed also a significant difference ( p<0.05 ). FUL was significantly shorter in incontinent patients than in the control group ( p=0.0112 ). But pairwise comparison showed only a significant difference for the stress incontinence group compared with the control group ( p=0.0084 ) and not for the urge or mixed incontinent group. No clear correlation between SUL, FUL, and ICIQ-SF score was found. Conclusions . SUL measured by noninvasive perineal ultrasound is a suitable parameter in the assessment of female incontinence, since incontinent women show a significantly elongated urethra as a sign of tissue insufficiency, independent of the type of incontinence.
Objective: In the recent decades, transperineal ultrasonography has been used to examine patients in urogynaecology practice. In this study, we aimed to evaluate the function of transperineal ultrasonography in women with urinary incontinence.Methods: Forty-five patients who were admitted to our institution between December 2012 and May 2013 and clinically and urodynamically diagnosed as having urinary incontinence (SUI n=20, DI+UUI n=13, MUI n=12) were included in the study. Additionally, 25 clinically and urodynamically continent women were included as the control group. The patients were evaluated using transperineal ultrasonography (USG) in the supine position during rest and straining. An abdominal probe was placed in the perineum vertically and sagittally; when the symphysis pubis, urethra, bladder, vagina, and rectum could be seen clearly on the monitor, the image was frozen. Posterior urethrovesical angle (PUVA), urethral length, bladder wall thickness, and residual urine volume were measured on the image. All measurements were compared statistically between the SUI, UUI, MUI groups, and control group. The post-void residual volume measured using transperineal ultrasonography was compared with the post-void residual volume measured using a catheter during urodynamics.Results: PUVA was significantly different in the SUI and MUI groups at rest than in the control group (p<0.05). During Valsalva maneuvers, PUVA was statistically significantly different in the SUI and MUI groups than in the UUI and control groups (p<0.01). Conclusion: The measurement of PUVA and bladder wall thickness by transperineal ultrasonography is shown to be useful in diagnosis of patients with suspected detrusor instability and structural defects in pelvic floor. Therefore, transperineal USG may be an easy and reliable method which could be an alternative to urodynamic studies in patients who cannot undergo urethral catheterization.
Introduction and hypothesis
Ultrasound measurement of urethral mobility is an attractive approach to directly visualize bladder neck descent (BND) during stress. BND assessed by transperineal ultrasound appears to be associated with stress urinary incontinence (SUI) severity. This study evaluated the inter- and intra-observer reliability of ultrasound BND measurement and its correlation with clinical examination.
Methods
We included 50 women from the multicenter randomized 3PN study (“Prenatal Perineal Prevention”). BND was measured by two operators either during pregnancy (at 20 weeks of gestation) or 2 months after delivery. Two measurements were taken by each operator. Intra-class coefficient correlations were used for analysis. Urethral mobility was clinically assessed by measuring the point Aa of the POP-Q classification during maximum strain (Valsalva maneuver) with an empty bladder.
Results
Ultrasound analysis showed high intra-observer reliability in the overall population: intraclass correlation coefficients (ICC) = 0.75 (0.59–0.85) and 0.73 (0.55–0.84) for each operator. Intra-observer agreements were considered moderate to high in the post- and antepartum groups. Inter-observer agreements were moderate in the antepartum period [ICC = 0.58 (0.26–0.78) for the first measurement and 0.68 (0.42–0.84) for the second] but low in the postpartum period [ICC = 0.15 (0.10–0.41) and 0.21 (0.10–0.58)]. Correlations between ultrasound and clinical measurements were considered low to moderate (Spearman coefficient, rho = 0.34 and 0.50 for post- and antepartum periods, respectively).
Conclusions
Inter-observer reliability of ultrasound urethral mobility measurements by the transperineal route is moderate antepartum and low postpartum. The correlation with point Aa is low to moderate.
