Urethral length and bladder neck behavior: can dynamic magnetic resonance imaging give the same results as introital ultrasound?
To compare dynamic magnetic resonance imaging (dMRI) and introital ultrasound results with regard to urethral length measurements and the evaluation of bladder neck changes.
Retrospective analyses of urethral length measurements and detection of bladder neck changes (rotated/vertical bladder neck descent, urethral funneling) were conducted in women—scheduled for surgical treatment with alloplastic material—who had undergone introital ultrasound and dMRI presurgery and 3 months postsurgery. Measurement differences between both imaging modalities were evaluated by assessing the confidence interval for the difference in means between the datasets using bootstrap analysis.
Based on data from 40 patients (320 image series), the urethra could be clearly measured on every pre- and postsurgical dMRI dataset but not on preoperative ultrasound images in nine women during Valsalva maneuver due to a large cystocele. The estimation of the mean difference distribution based on 500,000 bootstrap resamples indicated that the urethral length was measured shorter by dMRI pre- and postsurgery at rest and postsurgery during Valsalva maneuver (median 1.6–3.1 mm) but longer by dMRI (median 0.2 mm) during Valsalva maneuver presurgery. Rotated/vertical bladder neck descent and urethral funneling diagnoses showed concordance of 67–74% in the direct comparison of patients; the estimation of the concordance indicated poorer outcomes with 50–72%.
Metric information on urethral length from dMRI is comparable to that from introital ultrasound. dMRI is more advantageous in cases with an extended organ prolapse. At present, dMRI does not give the same diagnosis on bladder neck changes as introital ultrasound does.
KeywordsIntroital ultrasound Dynamic magnetic resonance imaging Urethral length measurement Bladder neck descent Urethral funneling
CDA: data analysis, manuscript writing, and manuscript editing. SMK: data collection and data management. PH: protocol development and manuscript editing. CS: project development and manuscript editing. HUK: project development. SBE: statistical analysis, data analysis, and manuscript editing. KAB: protocol development, data management, data analysis, and manuscript editing
The trial was self-funded.
Compliance with ethical standards
Conflict of interest
KA Brocker reports personal fees in the past by Serag Wiessner, Naila, Germany, outside the submitted work. All other authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants who were included in the study.
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