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P Chamberlain - One of the best experts on this subject based on the ideXlab platform.
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hysterosalpingo contrast sonography hycosy using Echovist 200 in the outpatient investigation of infertility patients
British Journal of Radiology, 1996Co-Authors: G Ayida, P Harris, S Kennedy, M Seif, D Barlow, P ChamberlainAbstract:Abstract This study describes the introduction of hysterosalpingo-contrast sonography (HyCoSy) as a first line outpatient investigation of uterine and tubal factors in two fertility units. 136 infertile women had transvaginal scanning before and during the intrauterine injection of contrast medium (Echovist®-200). HyCoSy was successfully completed in 132 cases (97%) within a mean time of 12.6 ± 8.4 (4–50) min. The uterus and its cavity appeared normal in 108 (82%) women. Uterine abnormalities in the remaining 24 women (18%) included structural abnormality (n = 7), fibroids (n = 12) and endometrial polyps (n = 5). A total of 261 fallopian tubes in 132 women were assessed: 186 (71%) appeared patent and 55 (21%) blocked. The remaining 20 (8%) could not be assessed for technical reasons. Polycystic ovaries and ovarian cysts were diagnosed in eight women. The most common adverse effect was mild/moderate pain, similar to period pain, with 24 (18%) women requiring simple analgesia. HyCoSy is a simple and well to...
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a comparison of patient tolerance of hysterosalpingo contrast sonography hycosy with Echovist 200 and x ray hysterosalpingography for outpatient investigation of infertile women
Ultrasound in Obstetrics & Gynecology, 1996Co-Authors: G Ayida, S Kennedy, David H Barlow, P ChamberlainAbstract:The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 ± 5.2 and 9.5 ± 4.8 min and 9.4 ± 5.2 and 11.5 ± 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy l4/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 8.5%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
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A comparison of patient tolerance of hysterosalpingo‐contrast sonography (HyCoSy) with Echovist®‐200 and X‐ray hysterosalpingography for outpatient investigation of infertile women
Ultrasound in Obstetrics & Gynecology, 1996Co-Authors: G Ayida, S Kennedy, David H Barlow, P ChamberlainAbstract:The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 ± 5.2 and 9.5 ± 4.8 min and 9.4 ± 5.2 and 11.5 ± 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy l4/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 8.5%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
Dirk W. Droste - One of the best experts on this subject based on the ideXlab platform.
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The identification of right-to-left shunts using contrast transcranial Doppler ultrasound: performance and interpretation modalities, and absence of a significant side difference of cardiac micro-emboli.
Neurological Research, 2004Co-Authors: Dirk W. Droste, Jörg Stypmann, Thomas Wichter, Ralf Dittrich, Heike Lakemeier, Martin A. Ritter, E. B. RingelsteinAbstract:AbstractCardiac and extracardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) as well as by transcranial Doppler ultrasound (TCD) using contrast agents that do not pass the lungs. Currently, the appropriate performance of a Valsalva manoeuvre (VM) to provoke the shunt, the use of different contrast agents and the classification of the TCD results are still under debate. In this study, we looked also at possible side effects of provoked cardiac micro-emboli in the left and right hemisphere. Seventy-one patients were investigated by both TEE and bilateral TCD of the middle cerebral arteries. The following protocol was applied in a randomized way: (1) Echovist®-300 without VM; (2) Echovist®-300, VM for 5 seconds starting 5 seconds after the beginning of contrast injection; (3) repetitive short VMs in between 2 and 13 seconds after the beginning of Echovist®-300 injection; and (4) repetitive short VMs in between 2 and 13 seconds after the beginning of agitated saline inject...
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Optimizing the Technique of Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts
Stroke, 2002Co-Authors: Dirk W. Droste, Jörg Stypmann, Thomas Wichter, Ralf Dittrich, Martin A. Ritter, Stefan Lakemeier, Martin Moeller, Michael Freund, E. B. RingelsteinAbstract:Background and Purpose— A cardiac right-to-left shunt (RLS) can be identified by transesophageal echocardiography and transcranial Doppler ultrasound (TCD) with contrast agents and a Valsalva maneuver (VM) as a provocation procedure. This article applies the modalities of these tests detailed in previous studies to a large patient cohort and compares 2 contrast agents (saline and Echovist-300). Methods— Eighty-one patients were investigated by both transesophageal echocardiography and bilateral TCD of the middle cerebral arteries. The following protocol with injections of 10 mL agitated saline was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, and (3) repetition of the test with VM if the first test with VM was negative. The VM was performed for 5 seconds starting exactly 5 seconds after the beginning of saline injection. Thereafter, the same protocol was repeated with 10 mL Echovist-300 instead of saline. Results— Thirty-one patients had a cardiac RLS. The Echovist-300 investigation disclosed all these 31 shunts, but saline disclosed only 29 of them. Twenty-two had an RLS only in at least 1 of the above TCD tests, some of them even with a considerable shunt volume. Conclusions— Contrast TCD performed with Echovist-300 but not with saline yields a 100% sensitivity to identify transesophageal echocardiography-proven cardiac RLSs. The TCD test should be repeated if negative the first time. This article gives detailed information for the optimization of the contrast TCD technique. Extracardiac shunts detected only during contrast TCD can have a considerable shunt volume and may allow for paradoxical embolism.
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contrast transcranial doppler ultrasound in the detection of right to left shunts comparison of Echovist 200 and Echovist 300 timing of the valsalva maneuver and general recommendations for the performance of the test
Cerebrovascular Diseases, 2002Co-Authors: Dirk W. Droste, Jörg Stypmann, Thomas Wichter, Ralf Dittrich, Martin A. Ritter, Matthias Grude, Ruta Jekentaite, Tjark Hansberg, Darius G Nabavi, Bernd E RingelsteinAbstract:Background and Purpose: Cardiac right-to-left shunts (RLS) can be identified by transesophageal echocardiography (TEE) as well as by transcranial Doppler ultrasound (TCD) using cont
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Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: Time window and threshold in microbubble numbers
Stroke, 2000Co-Authors: Dirk W. Droste, Jörg Stypmann, Thomas Wichter, Vendel Kemény, Karen Silling, Matthias Grude, Karsten Kühne, E. B. RingelsteinAbstract:Background and Purpose —Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods —Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. Results —In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions —TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.
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Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts Comparison of Different Procedures and Different Contrast Agents
Stroke, 1999Co-Authors: Dirk W. Droste, Kriete Ju, Jörg Stypmann, Castrucci M, Thomas Wichter, Ralf Tietje, B. M. Weltermann, Peter Young, E. B. RingelsteinAbstract:Background and Purpose —Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of different contrast agents and different provocation procedures. Currently, data on an appropriate time window for the appearance of contrast bubbles in the TCD recording after the injection of the contrast medium and the comparison of different provocation maneuvers to increase right-to-left shunting are insufficient. Methods —Forty-six patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with 6 injection modes was applied in a randomized way: (1) injection of 10 mL of agitated saline without Valsalva maneuver, (2) injection of 10 mL of agitated saline with Valsalva maneuver, (3) injection of 10 mL of a commercial galactose-based contrast agent (Echovist) without Valsalva maneuver, (4) injection of 10 mL of Echovist with Valsalva maneuver, (5) injection of 10 mL of Echovist with standardized Valsalva maneuver, and (6) injection of 10 mL of Echovist with coughing. Results —In 20 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt-positive). Sixteen patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 10 patients were only positive on at least 1 TCD investigation but negative during TEE. The amount of microbubbles detected in the various tests decreased in the following order: Echovist and Valsalva maneuver, Echovist with coughing, Echovist and standardized Valsalva maneuver, saline with Valsalva maneuver, Echovist, and saline. With a time window of 20 to 25 seconds for the bubbles to appear in the TCD recording and with a sequence of first Echovist and Valsalva maneuver and then Echovist with coughing, all shunts were reliably identified with a specificity of 65% compared with TEE as the traditional gold standard. The time of first microbubble appearance was not helpful to distinguish between shunts detected on TEE and other shunts. Conclusions —TCD performed twice with 2 provocation maneuvers using Echovist is a sensitive method to identify cardiac right-to-left shunts also identified by TEE.
G Ayida - One of the best experts on this subject based on the ideXlab platform.
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hysterosalpingo contrast sonography hycosy using Echovist 200 in the outpatient investigation of infertility patients
British Journal of Radiology, 1996Co-Authors: G Ayida, P Harris, S Kennedy, M Seif, D Barlow, P ChamberlainAbstract:Abstract This study describes the introduction of hysterosalpingo-contrast sonography (HyCoSy) as a first line outpatient investigation of uterine and tubal factors in two fertility units. 136 infertile women had transvaginal scanning before and during the intrauterine injection of contrast medium (Echovist®-200). HyCoSy was successfully completed in 132 cases (97%) within a mean time of 12.6 ± 8.4 (4–50) min. The uterus and its cavity appeared normal in 108 (82%) women. Uterine abnormalities in the remaining 24 women (18%) included structural abnormality (n = 7), fibroids (n = 12) and endometrial polyps (n = 5). A total of 261 fallopian tubes in 132 women were assessed: 186 (71%) appeared patent and 55 (21%) blocked. The remaining 20 (8%) could not be assessed for technical reasons. Polycystic ovaries and ovarian cysts were diagnosed in eight women. The most common adverse effect was mild/moderate pain, similar to period pain, with 24 (18%) women requiring simple analgesia. HyCoSy is a simple and well to...
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a comparison of patient tolerance of hysterosalpingo contrast sonography hycosy with Echovist 200 and x ray hysterosalpingography for outpatient investigation of infertile women
Ultrasound in Obstetrics & Gynecology, 1996Co-Authors: G Ayida, S Kennedy, David H Barlow, P ChamberlainAbstract:The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 ± 5.2 and 9.5 ± 4.8 min and 9.4 ± 5.2 and 11.5 ± 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy l4/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 8.5%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
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A comparison of patient tolerance of hysterosalpingo‐contrast sonography (HyCoSy) with Echovist®‐200 and X‐ray hysterosalpingography for outpatient investigation of infertile women
Ultrasound in Obstetrics & Gynecology, 1996Co-Authors: G Ayida, S Kennedy, David H Barlow, P ChamberlainAbstract:The aim of this study was to assess patient tolerance of two outpatient tests. Sixty-six infertile women were prospectively randomized to hysterosalpingo-contrast sonography (HyCoSy) (n = 34) or X-ray hysterosalpingography (HSG) (n = 32). The procedures were performed by the same operator. The uterine cavity outline and tubal patency were determined by both procedures. The mean times taken and the volume of contrast medium required for HyCoSy and HSG were similar: 12.1 ± 5.2 and 9.5 ± 4.8 min and 9.4 ± 5.2 and 11.5 ± 8.4 ml, respectively. Side-effects were assessed during the procedure, at 2h, 24 h and 28 days. The most common side-effect was pelvic pain, in 56/66 (84%) women, occurring during the procedures (HyCoSy 19/34 (56%); HSG 23/32 (72/%)) and/or in the following 24 h (HyCoSy l4/34 (41%); HSG 15/32 (47%)). This was described as less severe or equal to their usual period pains (HyCoSy 100%; HSG 8.5%). Only 12/66 (18%) women required simple non-steroidal analgesia (HyCoSy 8/34 (24%); HSG 4/32 (13%)). There were no significant differences between the two methods concerning the frequency or severity of pains at different stages during and after the procedure or analgesia requirements. HyCoSy and HSG are equally well tolerated outpatient procedures for assessing tubal patency and uterine abnormalities. In addition, HyCoSy avoids the risks of ovarian irradiation and allows scanning of the uterine corpus and ovaries at the same time. Copyright © 1996 International Society of Ultrasound in Obstetrics and Gynecology
S D Maguiness - One of the best experts on this subject based on the ideXlab platform.
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Embryo transfer and uterine junctional zone contractions. VIDEO
Human Reproduction Update, 1999Co-Authors: P Lesney, S R Killick, R L Tetlow, John S. Robinson, S D MaguinessAbstract:Embryo transfer is one of the most critical steps affecting the success rate of in-vitro fertilization (IVF) and has changed little since IVF was first described (Steptoe and Edwards 1978). While there is general agreement that a smooth embryo transfer is associated more frequently with successful outcome (Wood et al., 1985; Mansour et al., l990; Visser et al., 1993; Tomas et al., 1998) this opinion is not unanimous (Nabi et al., l997; Tur-Kaspa et al., l998). However, embryos have been found in the vagina following embryo transfer (Poindexter et al., l986; Schulman, 1986) and experimental studies of mock embryo transfer in humans showed expulsion of Methylene Blue in 57% of transfers (Mansour et al., l994) and movement of X-ray contrast medium towards the Fallopian tubes and cervix/vagina in 38 and 21% respectively (Knutzen et al., 1992). Uterine junctional zone (JZ) contractions or endometrial wavelike movements have been characterized in both natural (Ijland et al., 1996, 1997a,b; Kunz and Leyendecker, 1996) and assisted reproduction cycles (Lesny et al., l998b). Recently increased contractility before embryo transfer has been shown to be associated with a lower pregnancy rate (Fanchin et al., 1998). As JZ contractility is minimal and progressively decreases during the luteal phase (Ijland et al., 1996; Lesny et al., 1998b), interference with the endometrium at embryo transfer may change the contraction pattern and affect implantation in a mechanical way. The observation of JZ contractions after mock embryo transfer in oocyte donors (Lesny et al., l998a) provides information about possible treatment outcome. It also demonstrates a connection between the ease of transfer, JZ contractions and mobility of mock embryos in utero. An atraumatic embryo transfer (with a soft end of the catheter, without touching the uterine fundus) did not have any effect on JZ contractility or movement of the mock embryo (Echovist). Difficult embryo transfers (mimicked by touching twice the uterine fundus with soft end of the catheter) generate strong fundo–cervical and random waves in the fundal area which were able to relocate mock embryos towards the cervix and/or into the intramural segment of the Fallopian tube. Contractions were also present when we stimulated uterus with the softer version of the catheter but their effect on mock embryos was to a lesser extent. We chose fundal stimulation because in our opinion it was the most frequent type of stimulus unwillingly given to the uterus at embryo transfer and is not usually considered as a problem. Moreover, we also noted that the application of a tenaculum to the cervix, as occasionally used during embryo transfer to correct the uterine position, could trigger JZ contractions (Lesny et al., 1998c). A further analysis of our 6 years clinical data revealed that an ectopic pregnancy was 3.9 times (95% CI from 1.5 to 10.2) more frequently associated with a difficult embryo transfer than with an easy procedure (Lesny et al., 1998d). In conclusion, the above facts confirm the existence of a mechanical force, which can be one of the decisive factors for embryos to remain in utero. Junctional zone contractions and endometrial wavelike movements of adjacent endometrium can provide an explanation for several clinical facts like lower success rate after difficult embryo transfer or higher ectopic and heterotopic pregnancy rates after IVF–embryo transfer treatment. They also highlight a need for atraumatic embryo transfer without touching the uterine fundus and without manipulation within the cervical area. The benefits arising from using softer catheters or pharmacological assistance at the time of embryo transfer remain to be tested.
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embryo transfer can we learn anything new from the observation of junctional zone contractions
Human Reproduction, 1998Co-Authors: P Lesny, S R Killick, R L Tetlow, J Robinson, S D MaguinessAbstract:To assess whether embryo transfer can alter junctional zone contractility, we studied the effect of easy and difficult mock transfers in 14 oocyte donors during in-vitro fertilization (IVF) cycles. An Echovist bolus (30 microl) was used to represent embryos and transfer medium. An 'easy' transfer was judged to be an atraumatic insertion of the catheter without touching the uterine fundus. A 'difficult' embryo transfer was mimicked by deliberately touching the uterine fundus twice with the soft end of the cannula. Transvaginal scan images were recorded, digitized and converted into five times normal speed to allow us to evaluate junctional zone contractility. Easy mock embryo transfers did not change endometrial mechanical activity. Echovist remained in the upper part of the uterine cavity and was not dispersed after 45 min. A difficult procedure generated strong random waves in the fundal area and waves from fundus to cervix which relocated the Echovist in six out of seven cases. We observed movements of the transfer bolus from the upper part of the uterus towards the cervix (four cases) and into Fallopian tubes (two patients). Our study confirms that the mechanical activity of the uterus is capable of relocating intrauterine embryos and that this activity depends on physical stimulation. Junctional zone contractions can be implicated in cases of IVF/embryo transfer failure or ectopic gestation.
Gabriel N Schaer - One of the best experts on this subject based on the ideXlab platform.
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sonographic evaluation of the bladder neck in continent and stress incontinent women
Obstetrics & Gynecology, 1999Co-Authors: Gabriel N Schaer, Ossi R Koechli, Daniele Perucchini, Eva Munz, U Peschers, John O L DelanceyAbstract:OBJECTIVE: To evaluate a new sonographic method to measure depth and width of proximal urethral dilation during coughing and Valsalva maneuver and to report its use in a group of stress-incontinent and continent women. METHODS: Fifty-eight women were evaluated, 30 with and 28 without stress incontinence proven urodynamically, with a bladder volume of 300 mL and the subjects upright. Urethral pressure profiles at rest were performed with a 10 French microtip pressure catheter. Bladder neck dilation and descent were assessed by perineal ultrasound (5 MHz curved linear array transducer) with the help of ultrasound contrast medium (galactose suspension-Echovist-300), whereas abdominal pressure was assessed with an intrarectal balloon catheter. Statistical analysis used the nonparametric Mann-Whitney test. RESULTS: The depth and diameter of urethral dilation could be measured in all women. During Valsalva, all 30 incontinent women exhibited urethral dilation. One incontinent woman showed dilation only while performing a Valsalva maneuver, not during coughing. In the continent group, 12 women presented dilation during Valsalva and six during coughing. In continent women, dilation was visible only in those who were parous. Nulliparous women did not have dilation during Valsalva or coughing. Bladder neck descent was visible in continent and incontinent women. CONCLUSION: This method permits quantification of depth and diameter of bladder neck dilation, showing that both incontinent and continent women might have bladder neck dilation and that urinary continence can be established at different locations along the urethra in different women. Parity seems to be a main prerequisite for a proximal urethral defect with bladder neck dilation.
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Usefulness of ultrasound contrast medium in perineal sonography for visualization of bladder neck funneling—first observations
Urology, 1996Co-Authors: Gabriel N Schaer, Bernhard Schuessler, Ossi R Koechli, Urs HallerAbstract:Abstract Objectives To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy with perineal ultrasound. Methods In 10 female patients with urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was intravesically administered and perineal ultrasound performed. The examination was done with the women in the upright position both without and with ultrasound contrast medium at rest and during pressing, and the pictures of the bladder base, bladder neck, and urethra were compared. Results With the patient in the upright position, the ultrasound contrast medium enters the urethra during pressing and bladder neck funneling is identified more accurately than without contrast medium. With Echovist, bladder neck funneling was detected in 9 of the 10 cases but without it in only 4 cases. Conclusions The use of ultrasound contrast medium results in a better visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence. This pilot study supports the necessity for further investigations in the use of ultrasound contrast medium as a diagnostic improvement of perineal ultrasound.
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Usefulness of ultrasound contrast medium in perineal sonography for visualization of bladder neck funneling-first observations
Urology, 1996Co-Authors: Gabriel N Schaer, Bernhard Schuessler, Ossi R Koechli, Urs HallerAbstract:Objectives. To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy with perineal ultrasound. Methods. In 10 female patients with urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was intravesically administered and perineal ultrasound performed. The examination was done with the women in the upright position both without and with ultrasound contrast medium at rest and during pressing, and the pictures of the bladder base, bladder neck, and urethra were compared. Results. With the patient in the upright position, the ultrasound contrast medium enters the urethra during pressing and bladder neck funneling is identified more accurately than without contrast medium. With Echo-vist, bladder neck funneling was detected in 9 of the 10 cases but without it in only 4 cases. Conclusions. The use of ultrasound contrast medium results in a better visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence. This pilot study supports the necessity for further investigations in the use of ultrasound contrast medium as a diagnostic improvement of perineal ultrasound.
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Improvement of perineal sonographic bladder neck imaging with ultrasound contrast medium
Obstetrics & Gynecology, 1995Co-Authors: Gabriel N Schaer, Bernhard Schuessler, Ossi R Koechli, Urs HallerAbstract:Objective To assess the efficacy of ultrasound contrast medium when imaging bladder neck anatomy in perineal ultrasound. Methods In 39 women with clinically and urodynamically proven urinary stress or stress-urge incontinence, a new echogenic contrast medium (Echovist) was administered transurethrally and perineal ultrasound was performed. Women were examined in the upright position both without and with ultrasound contrast medium at rest and during Valsalva maneuver, and the pictures of the bladder base, bladder neck, and urethra were compared. Results With the subject in the upright position, the contrast medium lay at the lowest point of the bladder and resulted in a reverse picture of the bladder base and bladder neck and clear visualization of these structures. In women with urinary stress incontinence, the ultrasound contrast medium entered the urethra during Valsalva, and bladder neck tunneling was identified more accurately than without contrast medium. With Echovist, bladder neck funneling was detected in 38 of the 39 cases, compared with only 19 when it was not used. Furthermore, when the bladder neck, urethra, or bladder base were not visible with plain perineal ultrasound, they were seen when ultrasound contrast medium was used. The contrast agent was well tolerated, and there were no adverse side effects. Conclusion The use of ultrasound contrast medium improves visualization of the bladder neck anatomy. Bladder neck funneling and urinary leakage are seen more distinctly, and this improves the diagnostic reliability in female urinary stress incontinence.
