Clinical Study Of 3D Sonography And VOCAL Method In Assessing Uthral Sphincter In Women With USI

Urinary Stressing Incontinence (USI) in women is a common problem that causes social morbidity and reduced quality of life. It can be cured by operation so doctors should get the message of pathological anatomy of the patients and type USI accurately.Three-dimensional ultrasound is a new technology that be used in clinical working since 1990s, 3D ultrasound provided three planes perpendicular to each other so could show the pelvic floor the female urethra the rectum and muscles in detail and accurately. Another important capability of 3D sonography is measuring the irregular volume such as the urethral sphincter accurately, many studies had proved the accuracy and reproducibility of 3D ultrasound.In this study, we showed the urethral sphincter in patients with USI by 3D multi-plane display, at the same time, measured the volume of the sphincter by 3D VOCAL method, so as to assess the clinical value of 3D ultrasound in USI, moreover, to compare its size in women with genuine stress incontinence and controls , tried to know the change of volume in patients of USI. In some cases the scan was analysed twice by different observers to assess the reproducibility of the measurements from the 3D scans.Materials and Methods25 cases of USI patients and 30 healthy subjects (controls) had 3D tran-srectal sonography using a 7. 5-MHz mechanical sector endoprobe ( Voluson 730D; Medison-Kretz Technik, Zipf, Austria)Three perpendicular planes were displayed simultaneously on the screen.Manipulation of the stored images allowed detailed morphologic assessment of the urethra periurethral tissues and urethral sphincter. The length, thickness, and volume of the rhabdosphincter were measured and compared between USI patients and controls. To address interobserver variability , 12 patients were measured by two examinators. Comparisions between groups were made by t-test using a SPSS for Windows computer application ( version 10. 0 ).ResultsAll the patients and the controls tolerated the transrectal ultrasonography without remarkable discomfort. 3D ultrasound clearly showed the anatomy char-actors of urethral and periurethral tissues. 3D multi-plance display could be used to observe and assess the morphologic components of the sphincter in patients of USI. Women with USI , compared with continent controls, had a significantly shorter thinner and smaller volume (P<0.01) of the striated urethral sphincter.3D VOCAL method accurendy measured the volume of the sphincter, there was no significent difference between the measurements of different observers ( P >0.05).Conclusions1. 3D ultrasound clearly showed the anatomy characters of urethral and periurethral tissues, it is a good tool to assess the morphologic components of urethral spincter in USI patients.2. Women with USI , compared with continent controls, had a significantly shorter thinner and smaller volume ( P <0. 01) of the striated urethral sphincter, proved that in USI patients, there are anatomical changes of the structure which maintained the urethral resistance.3. 3D ultrasound measurements of the irregular volume such as the urethral sphincter are reproducible,with satisfactory interobserver variance.