Journal article
Stress incontinence observed with real time sonography and dynamic fastscan magnetic resonance imaging--insights into pathophysiology
Scandinavian journal of urology and nephrology. Supplementum, Vol.207, pp.94-99; discussion 106-25
01/01/2001
DOI: 10.1080/003655901750175033
Abstract
Our concepts of pathophysiology of stress urinary continence have been greatly shaped by developments in radiographic imaging. Simple radiographs with and without contrast initially revealed the importance of urethral descent in pathogenesis. More recently, magnetic resonance imaging (MRI) and real time ultrasonography are showing soft tissue detail within both a global pelvic and a local urethral context. Careful examination of these studies can extend our concepts of pathophysiology and lead us beyond existing paradigms. We propose a unified theory of stress incontinence based on our dynamic fastscan MRI and real time ultrasonograms of stress incontinence, incorporating known details of pelvic anatomy, sphincteric location and function. The hypothesis introduces the concept of a continence threshold at which the urethra is subjected simultaneously to both shearing and explusive forces. If these forces are sufficient to overcome urethral coaptation at threshold, leakage results. The model proposes an anatomical sequence of changes through which the incontinent urethra cycles between periods of rest and increased abdominal pressure, and suggests a way in which repeated episodes of prolpase and urethral traction by shearing forces exerted by the vagina on the urethra may contribute to the development of intrinsic sphincteric deficiency.
Details
- Title: Subtitle
- Stress incontinence observed with real time sonography and dynamic fastscan magnetic resonance imaging--insights into pathophysiology
- Creators
- Jacek L MostwinRene Genadry - University of Iowa, Obstetrics and GynecologyRoger SaundersAndrew Yang
- Resource Type
- Journal article
- Publication Details
- Scandinavian journal of urology and nephrology. Supplementum, Vol.207, pp.94-99; discussion 106-25
- DOI
- 10.1080/003655901750175033
- ISSN
- 0300-8886
- eISSN
- 1651-2537
- Language
- English
- Date published
- 01/01/2001
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9983931812102771
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