Status Plus





Reconstructive Urogynecology, Dept.O&G, Faculty ofMed., Univ.s Indonesia, Jakarta, Indonesia.

Introduction: Urinaryincontinence is still a big problem faced by the world. There arethree studies comparing bladder neck mobility between patients withstress urinary incontinence (SUI) and continence group. Dietz’sstudy in 2002 involving 179 patients (mean age 49 years) withsymptoms of lower urinary tract concluded significant difference ofbladder neck mobility between groups.1 Two subsequentstudies, Dietz's and Bai's in 2004 concluded no significantdifference in both groups. Dietz’s research in 2004 usednulligravida population age 18-24 years2, while Bai’ssamples were 138 multiparous women, mean age 57 years old enteringmenopause3. Dietz performed measurements after the bladderwas emptied, while Bai ‘s when the bladder was filled up to itsmaximum capacity2,3. The results cannot be generalized tothe population of Indonesia due to race difference which may impactdifferentiation in incidence and bladder neck mobility4,5.Hence, specific studies for the population of Indonesia are needed.The researchers intend to know whether there were differences in themean of bladder neck mobility between those groups in Indonesia,especially in three different aspects, namely diagnostic criteria,comparised groups, and measurement.
Objective: To comparebladder neck mobility between patients with stress urinaryincontinence and continent women attending a tertiary Gynecologyclinic in Indonesia.
Methods: In a prospective study weassessed the pelvic floor anatomy of 74 women seen at an OutpatientGynecology Clinic between February 2014 and January 2015. Bladderneck descent on Valsalva was measured with three-/four-dimensional((3D/4D) translabial ultrasound imaging. Patients also completed ‘TheThree Incontinence questions (3I)’ Questionnaire. On clinicalexamination we recorded the result of a cough stress test. Data wereanalysed using SPSS 16.
Results: Seventy- four women hadcomplete data sets and were included in this study. Their mean agewas 42.2 (range, 30-63), their BMI was 25.3 (range, 17-37). Nopatient had previously undergone any gynecology or urogynecologysurgery. 56 had given birth vaginally with a mean vaginal parity of2.4 (1-5).
Table 1 gives results for measurements obtained at restand on maximal Valsalva as well as for bladder neck descent duringValsalva. There was no difference between continent and stressincontinent women for the distance between bladder neck and pubicsymphysis at rest. This distance was however significantly lower instress incontinent women on Valsalva: 6,3 (SD 7.1) mm vs 16.3 (SD5.2) mm, p = 0.0001. Mean bladder neck mobility in the SUI group wasmuch higher than in the stress continent group, 20.8 (SD 7.0) mm vs10.0 (SD 4.8) mm, p = 0.0001, see Table 2
Conclusions: Meanbladder neck distance to the pubic symphysis on valsalva was lower inwomen complaining of stress urinary incontinence, and mean bladderneck mobility was higher in the SUI group. This study is consistentwith data obtained in other ethnic groups and supports the hypothesisthat bladder neck mobility is a factor in the pathogenesis of stressurinary incontinence.Keywords: bladder neck mobility, stress urinaryincontinence, stress continence
References: 1. Dietz HP,Clarke B, Herbison P. Bladder Neck Mobility and Urethral ClosurePressure as Predictors of Genuine Stress Incontinence. Int UrogynecolJ. 2002;13:289-93. 2. Dietz HP, Eldridge S, Grace M, Clarke B. PelvicOrgan Descent in Young Nulligravid Women. Am J Obstet Gynecol.2004;191:95-9 3. Bai SW, Lee JW, Shin JS, Park JH, Kim SK, Park KH.The Predictive Value of Various Parameters in the Diagnosis of StressUrinary Incontinence. Yonsei Med J. 2004;45:287-92 4. Townsend MK,Curhan GC, Resnick NM, Grodstein F. The Incidence of UrinaryIncontinence Across Asian, Black, and White women in the UnitedStates. Am J Obstet Gynecol. 2010;202:378 e1-7. 5. Howard D, MillerJM, Delancey JOL, Ashton-Miller JA. Differential Effects of Cough,Valsalva, and Continence Status on Vesical Neck Movement. ObstetGynecol. 2000;95:535-40.