Morphologic manifestations and urethral function in female lower urinary tract symptoms: Correlation between ultrasonographic and urodynamic studies

Purpose: The aim of this study was to evaluate the morphologic features of female lower urinary tract symptoms and to examine the association between morphologic characteristics and urethral function. Materials and methods: The records of 1,341 women with lower urinary tract symptoms and one single urodynamic diagnosis were reviewed. These include 560 subjects with genuine stress incontinence, 130 with detrusor instability, 78 with mixed incontinence, 89 with hypersensitive bladder, 144 with voiding difficulty and 340 with negative findings on urodynamic studies. Thirty-six female volunteers with no symptoms associated with the lower urinary tract served as controls. All had ultrasonography to assess morphologic changes of the lower urinary tract qualitatively and quantitatively. Results: Hypersensitive bladder and control groups had significantly higher bladder neck position during stress, lesser rotational angle of the bladder neck, lower incidence of bladder neck funneling and cystocele formation, and lesser bladder wall thickness at the dome than did the other diagnostic groups, except for the incidence of bladder neck funneling in the voiding difficulty group. Excluding the incidence of cystocele development and bladder neck funneling, morphologic manifestations of female lower urinary tract symptoms did not vary with urodynamic diagnosis, except for hypersensitive bladder. Functionally, there was a significant difference in all parameters of urethral function among different diagnostic groups, except functional profile length. Micturition resistance was associated with resting bladder neck angle and bladder neck funneling (p = 0.004 and 0.034, respectively). Pressure transmission ratio at 1st quartile of the urethra was associated with cystocele (p = 0.004). Bladder wall thickness at the trigone was directly associated with maximum urethral closure pressure as well as pressure transmission ratios, and indirectly, with cystocele. Bladder wall thickness at the dome was associated with maximum urethral closure pressure and detrusor opening pressure (p = 0.004 and 0.046, respectively). Conclusion: Ultrasonography may provide another way to explore the pathophysiology of female lower urinary tract symptoms.