Imaging of Urethral Bulking Agents
Urethral bulking is an office procedure for treatment of stress urinary incontinence that has increased in popularity in recent years. Numerous types of urethral bulking agents (UBAs) have been used since its first introduction in the 1930s.
Ultrasound imaging has made it possible to clearly visualize the implanted UBAs and anatomic location of those agents. Typically, these agents are imaged using specialty 3D 360° field-of-view transducers. Urethral bulking can be readily imaged with transducers commonly found in most ultrasound departments. However, a sonographer, during a pelvic or renal examination, may inadvertently find and image an echogenic structure near the urethrovesical junction in patients with a history of urethral bulking. Familiarizing oneself with the sonographic appearance of UBAs and optimizing techniques to obtain improved images of these agents may eliminate the need for additional imaging for the patient.
In this chapter, we will focus on the sonographic characteristics of UBAs and on knowing when and how to use appropriate probes to image the urethra. We will also describe the use of 2D/3D perineal and 3D endovaginal ultrasound imaging in the assessment of urethral bulking. Normal anatomy, ultrasound techniques, and equipment will be briefly reviewed. The use of 3D endovaginal imaging to identify and describe the location and distribution of UBAs following uncomplicated transurethral injection will be covered as well.
KeywordsGenitourinary ultrasound Pelvic floor imaging Synthetic implanted materials 3-Dimensional endovaginal sonography
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