Urogynaecology

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The relationship between urethral mobility and parity

  1. KJ Dickie,
  2. KL Shek,
  3. HP Dietz

Article first published online: 7 JUL 2010

DOI: 10.1111/j.1471-0528.2010.02649.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 117, Issue 10, pages 1220–1224, September 2010

Additional Information

How to Cite

Dickie, K., Shek, K. and Dietz, H. (2010), The relationship between urethral mobility and parity. BJOG: An International Journal of Obstetrics & Gynaecology, 117: 1220–1224. doi: 10.1111/j.1471-0528.2010.02649.x

Author Information

  1. Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, New South Wales, Australia

*Prof. HP Dietz, Sydney Medical School Nepean, University of Sydney, Nepean Hospital, Penrith, NSW 2750, Australia. Email hpdietz@bigpond.com

Publication History

  1. Issue published online: 16 AUG 2010
  2. Article first published online: 7 JUL 2010
  3. Accepted 25 May 2010. Published Online 7 July 2010.

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Keywords:

  • Birth trauma;
  • bladder neck;
  • parity;
  • stress urinary incontinence;
  • ultrasound;
  • urethral mobility

Please cite this paper as: Dickie K, Shek K, Dietz H. The relationship between urethral mobility and parity. BJOG 2010;117:1220–1224.

Objective  Urethral mobility is associated with stress urinary incontinence (SUI) and urodynamic stress incontinence, and this is particularly true for mid-urethral mobility. The purpose of this study was to determine whether there is a significant relationship between segmental urethral mobility and vaginal parity in women undergoing urodynamic testing for prolapse or lower urinary tract symptoms.

Design  Retrospective study.

Setting  Tertiary referral service for multichannel urodynamic testing.

Population  Women undergoing urodynamic testing for lower urinary tract symptoms or pelvic organ prolapse.

Methods  The stored 3D translabial ultrasound volume data sets of 648 women were assessed. Measurements were performed using post-processing software in volumes obtained at rest and on maximal Valsalva manoeuvre. Analysis was based on a co-ordinate system using the dorsocaudal margin of the pubic symphysis. The urethral length was traced and divided into five equal segments. Mobility vectors are determined by the formula √[(yV − yR)2 + (xV − xR)2], where V indicates Valsalva and R indicates rest, with ‘x’ as the vertical distance and ‘y’ as the horizontal distance from the dorsocaudal margin of the pubic symphysis.

Main outcome measures  Mobility vector lengths.

Results  The distal urethra is consistently the least mobile part of the organ, regardless of parity. Vaginal childbirth seems to increase urethral mobility by about 20% for all urethral segments (all P ≤ 0.009). The first vaginal delivery showed the greatest effect, particularly on mid-urethral mobility.

Conclusions  There is a significant association between urethral mobility and vaginal delivery in women seen for symptoms of pelvic floor dysfunction, affecting all segments of the urethra equally. Most of this effect seems to result from the first vaginal birth.

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