ROLE OF TRANSVAGINAL ULTRASONOGRAPHY IN DiAGNOSIS OF STRESS URINARY INCONTINENCE IN FEMALE

Abstract

Stress urinincontinence is involuntary leakage of urine as a result of mcrease intra-abdominal pressure due to the inability of the urethral sphincter to maintain a higher pressure in the urethra than in the bladder.

Several factors are responsible for closure of the out- flow tract. The intrinsic mechanism, which acts along the length of the urethra, depends upon the functioning of several constituents of the urethral wall. Blood vessels, elastin and collagen within the urethral wall, the urethral epithelium, and the innervation of the vesical neck and urethra are all responsible for sphincteric function. The proximal mechanism, which closes the bladder neck, results . from the tone and arrangement of the smooth muscle fibers in this region. The extrinsic continence mechanism comprises the periurethral pelvic floor striated muscles, which are under somatic neural control. The levator ani muscle plays an important part in urinary continence by providing an additional occlusive force on the urethral wall, particularly during events associated with an increase in intra­ abdominal pressure, such as coughing and sneezing.

The clinical diagnosis of stress urinary incontinence is based on the patient history, observation of the incontinence during clinical examination, corroborating urodynamic studies when indicated, and different imaging modalities including the transvaginal ultrasound.

A part from being an appropriate technique to investigate the function of the lower urinary tract, Transvaginal ultrasongraphy has an additional benefit of describing the anatomy in a consistent .and reproducible manner. The non invasive nature of the technique provides a significant contrast to current urodynamic standards; it is painless, easy to perform and has been welcomed by both patients and clinicians. TVUS is, and readily accepted by the patients.