MRI urethrovesical junction mobility is associated with global pelvic floor laxity in female stress incontinence

Abstract

To assess in a population of stress incontinent patients without genital prolapse whether urethrovesical junction mobility is associated with global pelvic floor laxity. Dynamic MRI of 40 patients referred prior to surgery for urinary stress incontinence were reviewed retrospectively. The orientation of the urethrovesical junction was evaluated at rest and at straining in reference to the pubococcygeal line, and defined as the bladder neck pubococcygeal angle. The urethrovesical junction mobility was calculated as the difference between the bladder neck pubococcygeal angles at rest and at straining. Urethrovesical junction mobility and bladder neck pubococcygeal angles at rest and at straining were tested for correlations with the resting and straining position of different pelvic organs, urogenital hiatus size, levator plate angle, and anterior rectal bulging when straining. Urethrovesical junction mobility was correlated with the position of the bladder neck (p<0.0001), bladder base (p<0.0001) and uterine cervix (p<0.0001) at straining, as well as the hiatus length (p=0.0012) and width (p=0.0002), and levator plate angle (p <0.0001). The bladder neck pubococcygeal angle at rest was correlated with the resting position of the bladder neck (p <0.0001), bladder base (p <0.0001), uterine cervix (p=0.02), and the hiatus length (p=0.0004) and width (p=0.045) at rest, whereas the bladder neck pubococcygeal angle at straining was correlated with the straining position of the bladder neck (p <0.0001), bladder base (p=0.0001), uterine cervix (p <0.0001), and hiatus length (p=0.0005) and width (p=0.0004), and levator plate angle (p <0.0001) at straining. In a population of stress incontinent patients, the urethrovesical junction mobility was correlated with global pelvic floor laxity.