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Discrimination of Bladder Disorders in Female Lower Urinary Tract Symptoms on Ultrasonographic Cystourethrography

Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei Medical University (J.-M.Y.), and Department of Obstetrics and Gynecology, Cathay General Hospital (W.-C.H.), Taipei, Taiwan, Republic of China.

Address correspondence and reprint requests to Jenn-Ming Yang, MD, Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, 92 Chung-Shan North Rd, Section 2, Taipei 104, Taiwan, Republic of China.

Objective. To evaluate morphologic features of bladder disorders in female lower urinary tract symptoms using ultrasonographic cystourethrography and to elucidate the anatomic association of these morphologic characteristics. Methods. Ultrasonographic cystourethrography was performed in 1049 women with lower urinary tract symptoms and 1 single urodynamic diagnosis, including 764 patients with genuine stress incontinence, 190 with detrusor instability, and 95 with a hypersensitive bladder. Thirty-six women with no lower urinary tract symptoms served as control subjects. Ultrasonographic assessment included measurement of the bladder neck position at rest and during stress and observation of the development of bladder neck funneling and cystocele during the Valsalva maneuver. Results. Hypersensitive bladder and control groups had a significantly higher bladder neck position at rest and during stress, a lesser rotational angle of the bladder neck, a lower prevalence of bladder neck funneling and cystocele formation, and lesser mean bladder wall thickness than the other diagnostic groups. In the study groups, age, parity, and menopause may have effects on the cystourethrographic parameters except rotational angle and funneling of the bladder neck. With control of the confounding factors, bladder wall thickness at the trigone and dome was negatively correlated with the resting bladder neck angle (P = .006 and 0.019, respectively). Bladder wall thickness at the dome was positively associated with the rotational angle of the bladder neck (P = .022). Funneling of the bladder neck and development of cystocele during stress were positively associated with the resting and straining bladder neck angles as well as the rotational angle of the bladder neck. Conclusions. Ultrasonographic manifestation of a hypersensitive bladder is significantly different from that of genuine stress incontinence and detrusor instability.

Key Words: lower urinary tract symptoms • ultrasonography • urodynamics

Abbreviations: HB, hypersensitive bladder • DI, detrusor instability • GSI, genuine stress incontinence • LUTS, lower urinary tract symptoms

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