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Korean Journal of Obstetrics & Gynecology 2003;46(8):1493-1499.
Published online August 1, 2003.
The Significance of an Open Bladder Neck in the Evaluation of the Female Stress Urinary Incontinence.
Jin Ho Choe, Jeong Ah Ryu, Dong Il Choi, Bo Hyun Kim, Kyu Sung Lee
1Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
2Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Abstract
OBJECTIVE
To determine the prevalence of an open bladder neck in women with stress urinary incontinence and to assess its clinical and urodynamic significance. METHODS: To evaluate the presence of an open bladder neck, a total of 356 women with stress incontinence were evaluated by static cystourethrography (CUG). An open bladder neck is a finding defined as the appearance of contrast medium in the proximal urethra at resting state (like a 'beak') without overt leakage. We classified the patients into two groups according to the presence of an open bladder neck on static CUG and compared 13 clinical parameters between the two groups. RESULTS: The open bladder neck finding was observed in 192 (53.9%) patients. Open bladder neck was more common in higher symptom grade, older age, more delivery history, greater bladder neck descent, and estrogen depleted patients. There was a significantly higher rate of intrinsic sphincteric deficiency (ISD) in the open bladder neck-positive group (37.5%) than the open bladder neck-negative group (23.2%) (p=0.01). The average abdominal leak point pressure (ALPP) of women with open bladder neck (82.8 cmH2O) was lower than that of women without open bladder neck (96.4 cmH2O) (p=0.003). CONCLUSION: The open bladder neck on static CUG has clinical and urodynamic significance. Although it is not diagnostic of ISD, the finding may reflect functional deficiencies of intrinsic sphincter. One should consider this parameter when evaluating patients, especially in the equivocal zone of ALPP 61-90 cmH2O.
Key Words: Stress urinary incontinence, Urography, Bladder


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