Comparison of cystographic findings of intrinsic sphincteric deficiency with urethral hypermobility causing urinary incontinence

Objectives: To evaluate the usefulness of standing and lateral cystograms for differentiation of intrinsic sphincter deficiency (ISD) from urethral hypermobility (UH) causing stress urinary incontinence (SUI). Materials and Methods: 67 female patients with urinary incontinence undergoing measurement of the Valsalva leak point pressure (VLPP) were included. 14 patients with VLPP <60 cm H₂O were operated for ISD causing SUI while 53 patients with VLPP >100 cm H₂O were operated for UH causing SUI. Three radiologists compared the cystographic findings. Results: The changes in posterior urethrovesical angle (PUVA) between stress and resting states were 12 ± 7.5° in ISD causing SUI and 32.8 ± 12.7° in UH causing SUI, and showed a statistically significant difference (p < 0.01). The beaking signs of the vesical neck on anteroposterior (AP) projection of the cystogram during a resting state were seen in 76% of ISD causing SUI. The difference was also statistically significant (p < 0.01). The existence of cystocele or the mean PUVA in two groups did not show a statistically significant difference. Conclusion: ISD should be considered in female patients with symptoms of urinary incontinence where there are changes in PUVA <20° on a lateral cystogram between a stress state and resting state in addition to the beaking sign of the vesical neck during a resting state.