International Atlas

by: Giancarlo Sarnelli M.D.

Measurement of the urethral mobility.

A like-Cartesian reference axis system is built on the image of pubis. Drawing a first line through the elliptic picture of the symphysis (pubic axis) and his perpendicular touching the arcuate ligament border (perpendicular axis) we can obtain a reference system that allow to calculate normal o abnormal mobility of urethra and vesical neck. 

In this subject the  visceral suspension is  normal at rest.

Sagittal perineal plane during straining revealing cervico-urethral hypermobility condition related to impaired urethral support.

 Perpendicular axis (1 and 2) drew on the pubic image and urethral axis drew on the superior urethra (3) permit to calculate the inclination angle value of urethra at their intersection.

 Normal values, in our experience, are comprise within 60 and 100 degrees during straining. The pathologic value observed (154°) provides a quantitative measurement of angular urethral hypermobility.

The distance of bladder neck from perpendicular axis (3) provides measurement of posterior mobility. The distance of bladder neck from pubis axis (4), provides height and the measurement of inferior mobility. 

The posterior distance, in this image, is of 23 mm. The inferior of 5 mm under the pubis axis. Normal values are less than 10-12 mm for posterior mobility with a grey zone of 5 mm and 7 – 10 mm above pubic axis for inferior mobility.

Sagittal perineal plane during pelvic floor contraction. 

The bladder and urethra return in a normal aspect. Bladder neck and posterior vesical wall are now in elevated position. In this subject aspects of hypermobility are only present during straining while at rest and during pelvic floor contraction there is no sign of that.