Ultrasonic Assessment of a Paravaginal Defect before

Overview

Objective:
The aim of our study was to analyze whether transabdominal and introital ultrasono-graphy can accurately identify paravaginal defect associated with GSI (Genuine stress urinaryincontinence) and to determine the changes after paravaginal defect repair.Design: Prospective randomised clinical study.Setting: Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic.Methods: Sixteen women with GSI, who had previously not undergone anti - incontinence surgerywere involved. Their average age was 52 years, average weight 71 kg and average parity 2.0.Within vaginal examination our attention was focussed on the diminution of sulsus superiorisvaginae during Valsalva maneuver. The bladder of a patient in supine position was filled with 300ml of sterile saline. Than a 5 MHz curved array probe was used to assess the bladder neckmobility from the perineal approach, and the same probe was used from the abdominal approachto determine paravaginal defect and subsequently a vaginal probe from introital approach wasused for the rest of the examination. After Burch colposuspension and paravaginal defect repairUS scanning was performed 6 till 8 days and 5 or 6 weeks after operation.Results: We found significant differences in bladder neck position and mobility before and afterthe operation. In women with symptoms of GSI we found from abdominal approach unilateral orbilateral paravaginal defect in fifteen women. Unilateral defect was found on the right side sixtimes and on the left side only once. In eight women the defect was bilateral. The introitalapproach obtained similar results, only in two patients with bilateral defect the examinationconcluded unilateral right defect. After the operation we did not find PVD in patients afterparavaginal defect repair. We obtained worse results from vaginal examination, where preopera-tively PVD was correctly determined (sensitivity) only in 82.6%.Conclusion: From our preliminary results we can suggest performing US scanning to conformparavaginal defect before anti - incontinence surgery and possibly adding to the Burch colposus-pension paravaginal defect repair to correct cystourethrocele.

Key words:
female urinary incontinence, ultrasonography, paravaginal defect