الفهرس | Only 14 pages are availabe for public view |
Abstract Stress urinary incontinence is the leakage of urine on stress or exertion which is the most common cause of incontinence in young women and second in the old women. Pelvic muscle dysfunction and sagging as a result of elderly, obesity, pregnancy and vaginal delivery causes SUI because of the disrupted ligament of the urethra and weakness of pelvic muscle floor. This sagging of the pelvic floor leads to abnormal descent of the urinary bladder, uterus, vagina and rectum therefore increase incidence of SUI. The pelvis is categorized into three components anterior compartment contains bladder and urethra, middle compartment is containing vagina and uterus and lastly posterior compartment contains anus and rectum. The tissues that anchoring these compartments are the ligaments and the muscles of the pelvic floor. The damage to the supporting structures of these compartments leads to SUI. The degree of the disruption of the urethral ligaments and puboperineal muscles should be estimated in the SUI cases to be diagnosed and managed correctly. The conventional ways of diagnosis of pelvic floor dysfunction include voiding cystourethrogram, ultrasound and urodyamic but in recent years with advances in technology MRI proved to be the best to detect the degree of the floor dysfunction and to know which structure is damaged as dynamic MRI can detect and grade the pelvic floor relaxation by using HMO system, estimate width of the Levator hiatus and assessment of the iliococcygeal angle. Endovaginal MRI appears to be the most precise way to know the causing structural damage by imaging the urethra and its anchoring ligaments, detecting and estimating the damage to the pubic component of the Levator ani muscle, and to detect the damage of three levels of fascial support of DeLancey. |