الفهرس 
Structure in Relation to Function and ContinenceOnly 14 pages are availabe for public view
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Abstract
Urinary stress incontinence is a condition whereby
involuntary urine loss is a social or hygienic problem and is objectively demonstrable (Marana et
at, 1996). This definition may refer to a symptom or complaint on the part of the patient to a
sign detected upon physical examination or to a condition associated with a specific urodynamic
diagnosis (Bates et al., 1977).
The clinical diagnosis of genuine stress incontinence is based on the patient history, observation
of the incontinence during clinical examination, corroborating urodynamic studies and objective
demonstration of bladder neck hypermobility.
The consistent anatomical feature of uncomplicated genuine stress incontinence is the downward and
posterior rotational movement of the bladder neck to a dependent position below the margin of the
pubic bone m response to increased intraabdominal pressure.
This movement prevents pressure transmission to the bladder neck and proximal urethra to compensate
for the pressure transmitted to the bladder, leaving the intrinsic continence mechanism overwhelmed
Gohnson et al., 1992).
The degree of bladder neck movement has been used to classify stress incontinence patients and to
guide management decision.
The main effect of surgery for stress incontinence is to better support urethrovesical junction and
thus to enable a more effective abdominal pressure transmission to the proximal 11rethra at the
time of stress whereas the aim of suspension operation in the treatment of stress urinary
incontinence is to elevate and fix the bladder neck (Schaer et al.,1995).
Based on the fact that the main factor concerning continence is the rotation angle
and descent of the bladder neck during stress and there are anatomical
derangement demonstrated in stress incontinence patient, therefore, a variety· of methods
have been advanced to demonstrate objectively bladder neck hypermobility associated with
stress incontinence including the simple cotton swab test, standing bead-chain cystograms
and sophisticated and expensive cine cystography with simultaneous urodynamics.
·
Linear array ultrasound techniques were utilized in place of conventional radiologic procedures to
study the dynamics of the urethrovesical junction and proximal urethra in patients with urinary
incontinence (Bhatia et al., 1987). Holmes (1971) was the first to demonstrate the ease and
accuracy of evaluating the static urinary bladder with ultrasound techniques in terms of
residual urine, the mobility of the bladder wall, distortion of the bladder contour by adjacent
pelvic pathologic conditions and detection and evaluation of bladder tumour. Abnormal movement of
the bladder neck with cough or Valsalva’s maneuver can be visualized with real-time sonography with
negligible risk, minimal patient discomfort and no exposure to ionizing radiation (Quinn et a!,
1989).
Ultrasonographic imaging enables the objective determination of bladder neck position and
movement ion stress urinary incontinence (Schaer et a!., 1995) where the image of the symphysis
pubic serves as a reference point and all changes of anatomical position of the bladder neck are
related to the symphysis.