INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.
- MeSH
- Anal Canal diagnostic imaging MeSH
- Adult MeSH
- Urinary Incontinence diagnostic imaging etiology physiopathology MeSH
- Pregnancy Complications * diagnostic imaging physiopathology MeSH
- Humans MeSH
- Pelvic Floor Disorders * diagnostic imaging physiopathology etiology MeSH
- Pelvic Floor * diagnostic imaging physiopathology MeSH
- Prospective Studies MeSH
- Pregnancy MeSH
- Ultrasonography MeSH
- Urethra diagnostic imaging physiopathology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Práce shrnuje současné znalosti o příčinách, diagnostice, léčbě a komplikacích poranění močové trubice. Tato poranění se mnohem více vyskytují u mužů než u žen a nejčastější příčinou je zavádění katétru do uretry a endoskopická vyšetření a výkony. Základní vyšetření zahrnuje anamnézu, klinické a radiologické vyšetření doplněné ve vybraných případech o endoskopii. Existuje celé spektrum léčebných možností od pouhého sledování, přes prosté zavedení drenáže (katétr, epicystostomie) až po komplikované rekonstrukční výkony. Správná prvotní péče a další kroky jsou klíčové pro celkové výsledky a následky pro pacienta. Kvůli jednodušší struktuře a menším rozměrům ženské uretry, je článek zaměřený na mužské pacienty, ale obsahuje důležité poznámky o rozdílech v diagnostice a léčbě mezi pohlavími.
This article summarizes the recent knowledge on the etiology, diagnosis, therapy and complications of urethral injuries. There is much higher overall incidence in males than in females and the most common cause is urethral catheterization and endoscopic examination and procedures. Basic evaluation comprises patient ́s history, clinical and radiological examination with endoscopy in selected cases. There is a wide scale of treatment options from clinical follow-up, through simple insertion of drainage (catheter, epicystostomy) up to complicated surgical reconstructions. Proper primary managment and further steps are crucial for the final results and consequences for the patient. Due to tiny structure and short course of the female urethra it is focused on male patients, but important comments about differences in the diagnosis and therapy between the genders are mentioned.
Fraktura penisu se sdruženým poraněním uretry je vzácný akutní stav v urologii. Diagnostika se provádí převážně pomocí anamnézy, fyzikálního vyšetření, retrográdní uretrografie (v případě podezření na poranění uretry), případně magnetické rezonance (MRI). Při prokázané FP s poraněním uretry či při diagnostických pochybách je indikována operační revize se suturou tunica albuginea a uretry. Konzervativní terapie se nedoporučuje z důvodu rizika komplikací (erektilní dysfunkce, zakřivení penisu, striktura uretry).
Penile fracture with associated urethral injury is a rare acute condition in urology. The diagnosis is mainly based on medical history, physical examination, retrograde urethrography (in the case of suspected urethral injury), and/or magnetic resonance imaging (MRI). When penile fracture with urethral injury has been demonstrated or if there is diagnostic doubt, surgical revision with suture of the tunica albuginea and urethra is indicated. Conservative treatment is not recommended because of the risk of complications (erectile dysfunction, penile curvature, urethral stricture).
- Keywords
- leak point pressure, cystometrie, uroflowmetrie,
- MeSH
- Diagnostic Techniques, Urological * MeSH
- Electromyography methods MeSH
- Humans MeSH
- Urinary Bladder diagnostic imaging MeSH
- Urination Disorders diagnosis MeSH
- Flowmeters MeSH
- Urinary Incontinence, Stress diagnosis MeSH
- Lower Urinary Tract Symptoms diagnosis MeSH
- Urethra diagnostic imaging physiopathology MeSH
- Urodynamics * MeSH
- Check Tag
- Humans MeSH
- MeSH
- Diagnostic Techniques, Obstetrical and Gynecological classification MeSH
- Diagnostic Techniques, Urological classification MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Urinary Bladder * anatomy & histology diagnostic imaging MeSH
- Pelvic Floor diagnostic imaging MeSH
- Radiography methods MeSH
- Rectum diagnostic imaging MeSH
- Ultrasonography methods MeSH
- Urethra diagnostic imaging MeSH
- Urogenital System * diagnostic imaging MeSH
- Urologic Surgical Procedures MeSH
- Check Tag
- Humans MeSH
- Keywords
- cystometrie,
- MeSH
- Diagnostic Techniques, Urological * MeSH
- Urinary Bladder, Overactive diagnosis MeSH
- Urinary Incontinence * diagnostic imaging diagnosis MeSH
- Humans MeSH
- Urinary Bladder diagnostic imaging physiopathology MeSH
- Urination Disorders diagnostic imaging diagnosis MeSH
- Surveys and Questionnaires MeSH
- Urinary Incontinence, Stress diagnostic imaging therapy MeSH
- Urethra diagnostic imaging physiopathology MeSH
- Urodynamics MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Review MeSH
- MeSH
- Endoscopy * MeSH
- Humans MeSH
- Young Adult MeSH
- Penis diagnostic imaging injuries MeSH
- Replantation methods MeSH
- Self Mutilation diagnostic imaging surgery MeSH
- Amputation, Traumatic diagnostic imaging surgery MeSH
- Urethra diagnostic imaging surgery MeSH
- Check Tag
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Publication type
- Letter MeSH
- Case Reports MeSH
Endoskopie je minimálně invazivní diagnostická nebo terapeutická metoda. Umožňuje zjištění stavu tělních dutin nebo dutých orgánů za využití tělních otvorů nebo nepřímé cesty. Používají se speciálně upravené rigidní tubusy s optickým systémem tvořeným klasickými čočkami nebo ohebné (flexibilní) přístroje s optickými vlákny. Endoskopy umožňují diagnostiku a terapii různých patologických stavů močových cest, jako jsou nádory, cizí tělesa, obstrukce močových cest. Derivace moči znamená zajištění odtoku moči z organismu jinou než přirozenou cestou. Článek popisuje možnosti jednotlivých druhů endoskopie a derivací moči v urologii a je určen specialistům z jiných oborů a praktickým lékařům a neslouží k detailnímu popisu jednotlivých metod.
Endoscopy is a minimally invasive diagnostic or therapeutic method. It allows to examinate the status of a body cavity or holloworgans using the body openings. Endoscopes are specially modified rigid tubes with an optical system composed of conventionallenses or flexible devices with optical fibers, which allow the diagnosis and therapy of various pathologies of the urinary tract suchas tumors, foreign bodies and urinary tract obstruction. Urinary diversion means urine drainage from the body other than thenatural way. Article describes the different types of endoscopy and urinary diversion in urology and is intended for non-urologyspecialists and GPs and is not used for a detailed description of the methods.
- Keywords
- cystouretroskopie, ureterorenoskopie, epicystostomie,
- MeSH
- Cystectomy MeSH
- Cystoscopy MeSH
- Urinary Diversion methods MeSH
- Endoscopy * methods MeSH
- Prostatic Hyperplasia diagnostic imaging surgery MeSH
- Laser Therapy MeSH
- Kidney diagnostic imaging MeSH
- Humans MeSH
- Urinary Bladder Neoplasms diagnostic imaging surgery MeSH
- Nephrostomy, Percutaneous MeSH
- Stents MeSH
- Ureteroscopy MeSH
- Urethra diagnostic imaging MeSH
- Urologic Diseases * diagnostic imaging surgery MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH