ABSTRACT

In this study we compared vascular intensity in female urethra in its midsagittal plane at 3 predefined parts (intramural, midurethral and distal) and in its axial plane at the level of midurethra (rhabdosphincter vs. the inner part of urethra) in premenopausal, nulliparous, continent patients. Eighteen nulliparous patients, mean age 32.67 years (range 18-53 years) with no pelvic floor disorders and no history of incontinence were enrolled in the study. In the first part of their menstrual cycle, the subjects underwent endovaginal ultrasound with the use of a biplane, high frequency (5-12 MHz) transducer. Vascular pattern of the urethra was obtained in color-doppler mode using both, the linear and transverse arrays of the transducer and the data were registered as video files in a stable position of the probe. For each patient two video acquisitions were taken, one in midsagittal plane, second in axial plane at the level of midurethra. For the quantitative assessment of the blood flow, a PixelFlux software was applied. The comparison of intensity among three levels of vascularity observed in sagittal section as well as the comparison of vascular intensity between outer (rhabdosphincter) and inner (circular smooth muscle, longitudinal smooth muscle and submucosa) rings of the urethra were performed. The results of the analysis show that the midurethra has got the largest intensity of vascularity, which is statistically significantly better that the latter part of urethra (intramural and distal parts). Statistical analysis showed the differences of vascular intensity between intramural part of urethra and midurethra (0.47, p < 0.05) and between midurethra and distal urethra (0.43, p < 0.05). No statistically significant differences were found between the vascular intensity of in outer and inner part of the midurethra; but on contrary the values were very similar (0.76, p < 0.05). High frequency transvaginal ultrasound with the use of Color Doppler mode is a very reliable method enabling visualization of urethral vessels distribution. The data obtained from the scans may be further analyzed with the use of dedicated software in order to define the intensity of urethral vascularity and different anatomical areas, which are responsible for various functionalities.