Die Bedeutung der urodynamisch gemessenen Blasenkapazität und der anhand sonographischer Parameter bestimmten Hypermobilität der Urethra im Kontext von Stress- und Dranginkontinenz sowie deren Mischform bei Frauen

摘要

Almost every forth woman is suffering from urinary incontinence. Most frequent types of urinary incontinence are stress urinary incontinence (SUI), over active bladder (OAB) and mixed urinary incontinence (MUI). Beside medical history and sonography, urodynamic testing is commonly used to differentiate between these forms of urinary incontinence. During urodynamic testing the bladder capacity is measured routinely. A small bladder capacity has already been described in patients with over active bladder. Neither in stress urinary incontinence nor in mixed urinary incontinence the meaning of bladder capacity has been analyzed. In this trial the evaluation of a possible relationship between bladder capacity and the type of urinary incontinence was the point of interest. Therefore three groups of women with urinary incontinence were formed, in detail stress urinary incontinence, over active bladder and mixed urinary incontinence. Additionally a continent control group was examined in order to verify the results. As already known from current literature smallest bladder capacity was found in patients with over active bladder. Patients suffering from stress urinary incontinence showed a significantly higher bladder capacity than patients with over active bladder. This mismatch in bladder capacity could be explained with small bladders in the OAB group but could also be a hint for large bladder capacities in patients with SUI. Though these patients presented the largest bladder capacity, a significant difference to the control group was not obvious. Probably a certain bias was created by the control group being continent but showing possible risk factors for SUI in their patient history. Another significant difference was apparent between stress and mixed urinary incontinence. A possible explanation would be that the component of overactivity had a stronger influence than stress component. As urodynamic testing is an expensive and invasive technique, there is desire to establish less invasive diagnostics like perineal sonography. Different sonographic markers for hypermobility of the urethra were measured in this trial and a comparison between the four groups was carried out including correlation analysis of bladder capacity and the sonographic findings. Finally no correlation was obvious. In consequence urodynamic testing so far remains the gold standard for diagnostic in urinary incontinence as it reveals not only morphologic aberrations but also functional changes.