The Functional Role of Transperineal Ultrasound in the Evaluation of Females with Urinary Incontinence Compared to Urodynamic Studies

Objective: To prospectively evaluate the role of transperineal ultrasound in the diagnosis of female with urinary incontinence compared to urodymanic studies as the golden standard. Patients and Methods: This study had institutional review board approval, and informed consent was obtained from all participants. This pilot study included twenty female patients, their age ranges from 24-50 year old (mean age 34.5 years). All patients underwent clinical examination, urodyanmic studies and transperineal ultrasound examination. According to the clinical findings 15 patients were diagnosed as mixed urinary incontinence (Involuntary leakage associated with urgency) and 5 patients as stress urinary incontinence (involuntary leakage on effort, exertion, sneezing or coughing. The transperineal ultrasound was conducted using an (GE. ultrasound machine). A 6.5 MHz end fire vaginal endoprobe was applied to the perineum in the axial and sagittal planes. The patients were examined at rest and during different grades of straining. The ultrasound criteria evaluated by the US include: 1- Bladder neck position 2- Posterior urethrovesical angle 3- Anterior urethral (rotational) angle 4- Urethral luminal diameter and wall thickness 5- Bladder wall thickness. Results: Out of 20 patients with urinary incontinence; 12 patients (60%) had positive sonographic findings. However 8 patients (40%) were negative on perineal ultrasound. The positive sonsograhic findings were as follow; urethral hyper-mobility and intrinsic sphincteric deficiency (ISD) were detected in 7 (35%) patients, 3 (15%) patients had only urethral hypermobilty, while ISD was diagnosed in 2 (10%) patients. The ultrasound was 100% in agreement with urodynamics diagnosis in patients with intrinsic sphincter deficiency. 71.5% in patients with both urethral hypermobility and intrinsic sphincter deficiency, while 66.7% in patients with urethral hypermobility only. Conclusion: Transperineal ultrasound is a simple, easily conducted examination that can be used as screening imaging modality in patients with urinary incontinence to diagnose patients who are in need for further assessment.