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Objective: To explore the functional and morphological impact of concomitant anterior vaginal reconstructive surgery on outcome of transobturator suburethral tape (TOT) procedures., Methods: This was a retrospective review and analysis of data from 196 women who had undergone a TOT procedure with or without concomitant anterior vaginal reconstructive surgery during a 30-month period. Retrieved data included clinical information and ultrasound findings. Ultrasound examinations assessed the tape location and tape tension at rest, on straining and during coughing. Ultrasound parameters representing tape location comprised the sagittal tape-symphysis pubis distance, sagittal tape-symphysis pubis angle and tape percentile (an indication of tape position along the urethra with respect to urethral length); those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end, central point and lower end of the tape and axial urethral central echolucent area at the center of the tape., Results: Of the 196 women, 117 had undergone a TOT procedure without concomitant anterior vaginal surgery (Group 1), 44 had undergone TOT placement with anterior colporrhaphy (Group 2) and 35 had undergone TOT placement with a transobturator vaginal mesh procedure (Group 3). At the 3-month follow-up, functional outcomes as well as resting and dynamic ultrasound findings were similar between women following TOT procedures without (Group 1) and with (Groups 2 and 3) concomitant anterior vaginal surgery. However, a significantly higher rate of urethral encroachment at rest was noted in Group 2., Conclusions: Concomitant anterior vaginal reconstructive surgery neither aggravates the functional outcome nor affects the ultrasound findings of TOT procedures., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Objective: To explore, using 4D ultrasound, the importance of location and tension of transobturator sub- urethral tape (TOT) with respect to surgical outcome., Methods: Enrolled into the study were 56 women who had undergone TOT placement in the treatment of urodynamic stress incontinence. Tape location and tension were assessed by 4D ultrasound with the women at rest, during straining and during coughing. Ultrasound parameters representing tape location included the sagittal tape-symphysis pubis distance (sTSD), sagittal tape-symphysis pubis angle (sTSA) and tape percentile (an indication of tape position along the urethra with respect to urethral length), while those representing tape tension included urethral encroachment, sagittal tape-urethra distances at the upper end (sTUDu), center (sTUDc) and lower end (sTUDl) of the tape and axial urethral central echolucent area at the tape center (aUCEAc)., Results: In women in whom the tape procedure had been successful, during increased intra-abdominal pressure sTSA and the incidence of urethral encroachment increased, while sTUDu, sTUDc, sTUDl and aUCEAc decreased. Compared with those reporting no stress urinary incontinence (SUI) symptoms, women who reported SUI postoperatively had lower tape percentile. Women with SUI postoperatively demonstrated no manifestation on ultrasound of urethral encroachment at rest or during increased intra-abdominal pressure. Women with postoperative overactive bladder (OAB) symptoms had shorter resting sTSD and larger resting sTSA than did women without OAB symptoms. Women reporting postoperative de novo or worsening voiding difficulty had larger resting sTSA and higher incidence of urethral encroachment at rest than did women without this difficulty., Conclusions: Both tape location and tape tension are associated with surgical outcome of TOT procedures. Assessment of tape location and tension can be achieved using 4D ultrasound., (Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.)

Objectives: To evaluate the intra- and interobserver reliability of a new method of assessing resting and dynamic urethral compression after midurethral tape procedures using three- and four-dimensional (3D and 4D) ultrasound., Methods: Thirty-one women who had undergone transobturator midurethral tape procedures at Cathay General Hospital were enrolled in the study and 4D ultrasound was performed pre- and postoperatively. Preoperative ultrasound assessment included measurement of the urethral central echolucent area (UCEA) in the axial plane. Postoperative ultrasound assessment included measurement of the tape-urethral distance (TUD) in the sagittal plane as well as UCEA and tape angle in the axial plane (ATA). The TUD was measured at the upper end (TUDu), central point (TUDc) and lower end (TUDl) of the tape. All pre- and postoperative ultrasound assessments were performed in women at rest, on maximum straining and during strong coughing. 4D ultrasound volume datasets were stored digitally and analyzed offline by two independent investigators blinded to clinical data and to each others' measurements. Intra- and interobserver reliability were evaluated using the intraclass correlation coefficient (ICC)., Results: There were significant reductions in TUDc, TUDl and UCEA during increased intra-abdominal pressure. ICC values for the measurement of TUD at rest, on straining and during coughing demonstrated very good reliability. ICC values for the pre- and postoperative measurement of UCEA at rest, on straining and during coughing demonstrated good to very good reliability. ICC values for the measurement of ATA at rest, on straining and during coughing demonstrated fair to good reliability., Conclusions: 4D ultrasound can be used to obtain measurements with good reliability in the assessment of urethral compression., (Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.)

Objectives: To examine the effect of individual patient factors (age, parity, body mass index, menstrual cycle, menopause, hormone replacement therapy, bladder neck position and urethral mobility) on the appearance of Doppler flow in urethral vessels, to investigate the association between the Doppler flow parameters and intrinsic urethral function, storage and voiding, and to explore differences in the urethral vasculature between subjects with and without urodynamic stress incontinence (USI)., Methods: Over a 4-year period we prospectively performed imaging studies in 355 women, including 244 who denied any lower urinary tract symptoms within the previous 3 months (Group A) and 111 who had had lower urinary tract symptoms (Group B). Studies included morphologic assessment and Doppler flow investigation of the lower urinary tract. Vascular flow velocity and vessel density in the urethral vasculature were measured. For women in Group B, multichannel urodynamic studies were also performed., Results: The urethral vasculature has five main branches of vessels. Their appearance was not affected by the menstrual cycle or menopause except for those of the anterior vaginal vessel and anterior branch of the middle urethral vessel. Other than that of the posterior urethral vessel, in which there was a correlation with parity, the resistance index (RI) was not affected by individual patient factors. However, there was a correlation between the vascular index (VI) and individual factors such as age (r = -0.336, P = 0.002), body mass index (r = -0.287, P = 0.028), menopause (r = -0.402, P < 0.001), and hormone replacement therapy (r = 0.392, P = 0.027). Only the VI and RI of the posterior urethral vessel correlated significantly with the urethral pressure profile. In subjects with lower urinary tract symptoms, the appearance of the urethral vasculature on power Doppler imaging and the corresponding RI and VI values were not correlated with objective evidence of USI., Conclusion: Patient factors may affect specific Doppler flow parameters of the urethral vasculature, which are related to intrinsic resting urethral closure. There is no difference in the appearance of the urethral vasculature in subjects with or without USI., (2006 ISUOG. Published by John Wiley & Sons, Ltd.)

Most urethral diverticula are thought to result from infection and obstruction of the paraurethral ducts and glands. When rupture of a resulting retention cyst or abscess occurs into the urethra, a diverticulum is formed. We report two cases of paraurethral abnormalities: urethral diverticulum and paraurethral abscess. Transvaginal sonography, with its high-resolution visualization of the lower urinary tract, may aid in the diagnosis and treatment of such disorders. Using three-dimensional technology, the internal architecture of the paraurethral abnormalities and their spatial relationship to the urethra and bladder, important considerations at surgery, are clearly demonstrated on ultrasonography. Complete excision of complex paraurethral anomalies may be performed under transvaginal sonographic monitoring without inadvertent injury to the bladder or urethra.

Objective: To explore the significance of hyperechogenic spots in the urethra on ultrasound cystourethrography., Methods: One hundred and five women with lower urinary tract symptoms who had undergone urodynamic study and ultrasound cystourethrography were included. Ultrasound cystourethrography was used to evaluate the morphology of the lower urinary tract, including the bladder neck position, bladder wall thickness at the trigone and dome, and presence or absence of hyperechogenic spots (urethral hyperechogenicity) in the urethra and their location and number., Results: Of the 105 women, 30 (29%) had hyperechogenic spots in the urethra, including 26 (87%) with only one spot; 17 (53%) of the echogenic spots were located in the proximal urethra, including four cases with multiple echogenic spots. No significant differences were found in the demographics, urinary symptoms, ultrasonographic, urodynamic and urethrocystoscopic findings between those women with and without urethral hyperechogenicity, except for parity (P = 0.030). There was no association between urethral hyperechogenicity and urinary symptoms. A weak but negative correlation between the number of echogenic spots in the urethra and maximum urethral pressure was found in the subgroup with urethral hyperechogenicity (r = -0.421; P = 0.023)., Conclusion: On ultrasound cystourethrography, a single echogenic spot in the urethra is not associated with specific urinary symptoms and does not affect urethral function., (Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.)

The tension-free vaginal tape (TVT) procedure was introduced as a minimally invasive surgical technique for treating female stress urinary incontinence. This procedure is supposed to be associated with less postoperative voiding dysfunction because the vaginal tape, theoretically, remains tension-free. Nevertheless, significant voiding dysfunction or complete urinary retention has been reported to complicate 2.8% to 7.6% of TVT procedures. We report a case of voiding dysfunction following a TVT procedure. Two-dimensional sonography revealed the tape situated beneath the mid-urethra. The spatial orientation between the vaginal tape and the urethral structure was clearly demonstrated on three-dimensional scanning. The urethra was indented from the posterior by the vaginal tape, resulting in acute constriction of the hypoechogenic region of the urethra. Urethral dilation was performed using Hegar dilators. Thereafter, the patient's voiding difficulty improved dramatically and the residual urine volume decreased. One week later, repeat sonography showed the hypoechogenic region of the urethra to have a normal configuration with a lesser degree of urethral indentation., (Copyright 2004 ISUOG. Published by John Wiley & Sons, Ltd.)