DYNAMIC DISPLACEMENT CHANGES OF THE BLADDER NECK WITH THE PATIENT SUPINE AND STANDING

Purpose: With the patient standing and supine we determine the differe nces in dynamic changes of the bladder neck and directions of dynamic bladder neck displacement. Materials and Methods: To evaluate the dyna mic movement of the bladder neck we recruited into the study 78 consec utive women 27 to 69 years old with various urogynecological complaint s. The anatomical changes of the bladder neck from rest to maximal str aining and from rest to holding were evaluated and compared with the p atients supine and standing. Results: Except for bladder neck rotation al angle with the patient standing, all parameters were significantly different from corresponding measurements with the patient supine. Mea n rotational angle of rest to maximal straining plus or minus standard deviation was 39.4 +/- 18.9 degrees when standing versus 39.8 +/- 23. 4 degrees when supine (p > 0.05). The distances between the bladder ne ck and symphysis pubis at rest, and during maximal straining and holdi ng the bladder neck in the supine position were significantly longer t han those in the standing position. The direction of bladder neck disp lacement from rest to maximal straining was more caudad and ventral wh en standing. The bladder neck moved cephalad and ventral when the pati ent was standing, and cephalad and dorsal with the patient supine and holding the bladder neck. Conclusions: The anatomical locations and dy namic displacements of the bladder neck at rest, and during maximal st raining and holding were significantly different in the supine and sta nding positions. While evaluating the dynamic motion of the bladder ne ck to determine bladder neck mobility, patient position must be consid ered and specified in accordance with diagnostic standards.