Urinary incontinence and voiding dysfunction

Pelviperineology 2012; 31: 59-61 http://www.pelviperineology.org The fourth section of the book “Pelvic floor disordersImaging and Multidisciplinary Approach to Management” is entitled “Urinary Incontinence and Voiding Dysfunction” and consists of nine chapters divided into two subsections describing diagnostic methods and management of these disturbances. In the first chapter “Ultrasonography” A. P. Wieczorek, M. M. Woźniak and A. Stankiewicz review basic information about techniques, equipment advantages, limitations, clinical usefulness, and the literature concerning ultrasound assessment in the diagnostics and monitoring of treatment of urinary incontinence (UI) and voiding dysfunctions (VD) with reference to two-dimensional (2D) and three-dimensional (3D) transperineal ultrasound (TPUS), as well as 2D and 3D endovaginal ultrasound (EVUS). Transperineal ultrasound (TPUS, Figure 1a-b) is recognized nowadays as a gold standard technique in the diagnosis of UI and VD and is a very useful method, which allows overall assessment of all anatomical structures (bladder, urethra, vaginal walls, anal canal and rectum) located between the posterior surface of the symphysis pubis and the ventral part of the sacral bone. However, EVUS offers significant amount of additional information providing detailed assessment of the morphology, vascularity, and functionality of the urethral complex and appears to play a relevant role in the management of these pathological conditions. The authors highlight the special role of more sophisticated modalities such as novel 3D, 4D high-frequency, endoluminal ultrasonography. They recommend high-frequency techniques as the ones, which have the biggest impact on the diagnostics and most probably in near future will become gold standard examinations in the diagnostics and monitoring of treatment of urinary incontinence and voiding dysfunctions. The second chapter “Urodynamics” by E. Ostardo, G. Tuc citto, F. Beniamin and L. Maccatrozzo provides information on urodynamic tests measure parameters related to the storage and voiding functions of the lower urinary tract. Investigations encompass a variety of tests, including uroflowmetry, cystometry, pressure-flow studies, urethral sphincter electromyography, video-urodynamics, urethral pressure profilometry and Valsalva leak point pressure test (Figure 2). The chapter describes in details each of the above mentioned methods, their indications, methodology, clinical usefulness and interpretation of the obtained results. The usefulness of urodynamics remains controversial, however it can provide a pathophysiological explanation of urinary dysfunction, guiding clinical management. If there are persistent criticisms of urodynamics and theirs role in selection patients for invasive management of lower urinary tract dysfunction there may be a need for randomized controlled trials. The third chapter entitled “Tape Positioning” written by M. Bogusiewicz and T. Rechberger describes the mechanism of action of midurethral slings, techniques of tape poUrinary incontinence and voiding dysfunction