Role of MRI in the Evaluation of the Female Urethra in Patients with Stress Urinary Incontinence

Abstract

Background:

                 Urinary incontinence, defined as involuntary leakage of urine, is one of the most common conditions in the female population that causes significant anxiety and negatively affects the quality of life. Urinary incontinence also has a considerable impact on health care costs. (Lalwani et al.,2013). 

            Dynamic evaluation of the urethral sphincter is possible with MRI and simultaneous functional and morphologic assessment may assist in classification of incontinent patients into hypermobility and intrinsic sphincter deficiency categories. The additional information on the status of the urethral sphincter and supporting ligaments provided by MR imaging may contribute to the diagnosis and staging of urinary incontinence in the female population.  (Peng et al.,2016).

          Treatment of patients with urinary incontinence depends on the type of sphincter abnormality. MR imaging contributes findings that characterize the urethral dysfunction and may guide the choice of therapy and posttreatment follow-up in the future. (Tasali , et al.,2012).

          The aim of the study was to evaluate the female urethra and its supporting structures in patients with stress urinary incontinence and to differentiate between urethral sphincter defect and urethral hypermobility as a cause of stress urinary incontinence.

Results:

       In our study, 50% have history of vaginal delivery trauma as compared to 30% in control group (P =0.451).

      There was no significant difference between the continent volunteers and incontinent patients in body habitus as assessed by the body mass index. 

       Both bladder neck funneling (absent vs present) and the functional suprapubic urethra sphincter length were found to be significantly associated with UDs diagnosis of SUI due to pure UH vs SUI with ISD component.

       MRI has shown good prediction statistics with 83.33% sensitivity ,100% positive predictive value, 94.74% negative predictive value and  100% specificity for funneling of the bladder neck and 83.33% sensitivity , 41.7% positive predictive value, 91.7% negative predictive value and 61.1% specificity respectively for suprapubic urethral length.

Conclusion:  

MRI plays an important role in assessing the contribution of urethral hypermobility and sphincteric dysfunction to the stress urinary incontinence in women when considering treatment options.