Simultaneous perineal ultrasound and urodynamic assessment of female urinary incontinence: Initial observations

Simultaneous perineal ultrasound and urodynamic evaluation was performed in 35 female patients suffering from urinary incontinence of varying etiologies and in 5 healthy continent women. The digitized ultrasound signals and urodynamic curves were simultaneously monitored on a computer screen. During cystometry, urethral pressure profile during stress, and micturition, this simultaneous technique correlates pressure measurements with the behavior of the urethrovesical junction. The influence of intra-abdominal pressure changes (coughing, straining) on the anatomy of the urethra and the urinary bladder, or the effect of pelvic floor and urethral sphincter contractions on the intraurethral and intravesical pressure, thereby becomes evident. The synchronous imaging of pressure variations and structural changes provides valuable information about the functional anatomy of the urethrovesical junction. On the one hand urodynamic phenomena, and on the other hand ultrasound findings, can be better understood than when the techniques are performed separately. With this simultaneous evaluation additional knowledge is acquired about the pathyophysiology of micturition disorders and incontinence. An advantage of ultrasound compared with radiological techniques is that the urethrovesical anatomy and the surrounding tissues are clearly imaged without irradiation and without the need for contrast medium.EDITORIAL COMMENT: The authors describe the simultaneous recording of urodynamic tracings on an ultrasound screen while visualizing the bladder neck, urethra, and bladder by perineal ultrasonography. Although this idea is not entirely new, having first been described by Kohorn et al. (1987) and confirmed by Koelbl et al. (1988), in this pilot study the urodynamic tracing is visualized on the same screen as the ultrasound image in real time. The result may be somewhat overwhelming at first, but may actually clarify functional aspects to the lower urinary tract hitherto unknown. This newest melding of sonographic and urodynamic information also has the distinct advantage of requiring no radiation or contrast medium exposure. With further experience and a larger study population, it will be interesting to see how this technique adds to our understanding and clinical evaluation of female incontinence.