AJR
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Abstract Freely available
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kim, J. K.
Right arrow Articles by Cho, K.-S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kim, J. K.
Right arrow Articles by Cho, K.-S.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?

The Urethra and Its Supporting Structures in Women with Stress Urinary Incontinence: MR Imaging Using an Endovaginal Coil

Jeong Kon Kim1, Yong Jae Kim2, Myoung Soo Choo2 and Kyoung-Sik Cho1

1 Department of Radiology, Asan Medical Center, University of Ulsan, 388-1 Poongnap-dong, Songpa-gu, Seoul, 138-736, South Korea.
2 Department of Urology, Asan Medical Center, University of Ulsan, Seoul, 138-736, South Korea.



View larger version (84K):

[in a new window]
  		Fig. 1. —Photograph and diagram of endovaginal coil. Coil, wrapped in supple rubber, was inserted into vagina so that entire urethra was covered. Inset diagram shows dimensions of coil.

 


View larger version (131K):

[in a new window]
  		Fig. 2A. —Normal anatomy of urethra and its supporting structures in 34-year-old continent woman. Axial T2-weighted fast spin-echo MR image obtained at level of approximately 30th percentile of urethra shows normal striated muscle, smooth muscle, and mucosa– submucosa layers of urethra. Normal periurethral and paraurethral ligaments, which maintain their tightness and can be traced along entire length without discontinuity, are shown. Symmetric puborectal sling is also noted.

 


View larger version (129K):

[in a new window]
  		Fig. 2B. —Normal anatomy of urethra and its supporting structures in 34-year-old continent woman. Drawing corresponds to A. SP = symphysis pubis, V = vagina, C = endovaginal coil, R = rectum, pr = puborectal sling, pa = paraurethral ligament, pe = periurethral ligament, st = striated muscle layer, sm = smooth muscle layer, m = mucosa–submucosa layer.

 


View larger version (138K):

[in a new window]
  		Fig. 2C. —Normal anatomy of urethra and its supporting structures in 34-year-old continent woman. Axial MR image obtained at approximately 50th percentile of urethra shows normal pubourethral ligament connecting urethra to arcus tendineus fasciae pelvis and caudal portion of periurethral ligament. Thickness of puborectalis sling, measured in 4- and 8- o'clock directions from urethra, is 4.2 mm in right limb and 3.8 mm in left limb. Therefore, mean thickness of puborectalis muscle is 4.0 mm and degree of asymmetry is 1.1.

 


View larger version (129K):

[in a new window]
  		Fig. 2D. —Normal anatomy of urethra and its supporting structures in 34-year-old continent woman. Drawing corresponds to C. SP = symphysis pubis, V = vagina, C = endovaginal coil, R = rectum, ATFP = arcus tendineus fasciae pelvis, pu = pubourethral ligament, pe = periurethral ligament, pr = puborectal sling.

 


View larger version (151K):

[in a new window]
  		Fig. 2E. —Normal anatomy of urethra and its supporting structures in 34-year-old continent woman. Sagittal T2-weighted fast spin-echo MR image obtained through long axis of urethra shows 117° vesicourethral angle (ag, intersecting lines) and retropubic space measuring 2.2 mm (r, arrows). BLD = urinary bladder, SP = symphysis pubis.

 


View larger version (136K):

[in a new window]
  		Fig. 3A. —Morphologic alteration of urethra and its supporting structures in 57-year-old woman with stress urinary incontinence. Axial T2-weighted fast spin-echo MR image obtained at level of approximately 30th percentile of urethra shows that striated muscle layer of urethra (arrowheads) is thin compared with normal muscle layer seen in woman imaged in Figure 2A. Fluttering periurethral ligament (straight arrows) and discontinuous paraurethral ligament (curved arrows) are evident. R = rectum, SP = symphysis pubis, V = vagina.

 


View larger version (147K):

[in a new window]
  		Fig. 3B. —Morphologic alteration of urethra and its supporting structures in 57-year-old woman with stress urinary incontinence. Axial MR image obtained at level of approximately 50th percentile of urethra shows discontinuous pubourethral ligament (arrows). R = rectum, SP = symphysis pubis, V = vagina.

 


View larger version (20K):

[in a new window]
  		Fig. 4. —Dot graph illustrates different distribution of degree of asymmetry of puborectal sling in continent group and in group with stress urinary incontinence. Most patients in both groups showed degree of asymmetry of less than 1.5. However, patients with degree of asymmetry equal to or greater than 1.5 are found only in group with stress urinary incontinence.

 


View larger version (149K):

[in a new window]
  		Fig. 5. —Axial T2-weighted fast spin-echo MR image obtained at level of approximately 50th percentile of urethra shows asymmetric puborectal sling (arrows) in 49-year old woman with stress urinary incontinence. SP = symphysis pubis, U = urethra, V = vagina, R = rectum.

 


View larger version (144K):

[in a new window]
  		Fig. 3C. —Morphologic alteration of urethra and its supporting structures in 57-year-old woman with stress urinary incontinence. Sagittal T2-weighted fast spin-echo MR image shows vesicourethral angle of 152° and retropubic space of 11 mm. BLD = urinary bladder, SP = symphysis pubis.

 


View larger version (21K):

[in a new window]
  		Fig. 6. —Dot graph reveals different distribution of scores for risk of stress urinary incontinence between continent group and group with stress urinary incontinence. Cutoff value = 1, sensitivity = 81.3%, and specificity = 95.2%.

 


View larger version (27K):

[in a new window]
  		Fig. 7. —Graph shows receiver operating characteristic curve for risk score of stress urinary incontinence. Area under curve = 0.930 (95% confidence interval, 0.850–0.975).

 

Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?



HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2003 by the American Roentgen Ray Society.