Reducing uncertainty for vesico-urethral sonography in women

The author endeavours to detail the technical modalities which can be used to avoid uncertainty in urodynamic sonography, and to obtain easily reproducible quality imaging. The 5 major techniques (transparietal, transperineal, introital, endovaginal and endorectal) are compared. The artifacts generated are described. A choice between these different techniques is performed as a function of the methodological advantages specific to each of them and the clinical applications contemplated by the sonographer. The characteristics of the "ideal" equipment are defined to help the sonographer-to-be to choose his or her equipment with full awareness of the facts (characteristics of the probe, emission frequency, settings by the sonographer, automatic image freeze during coughing). The methodology is described in detail and widely illustrated: position of the patient, choice of the section plane, choice of the reference system, location of the urethra, and definition of the vesical neck, maintenance of the probe position during effort or free movement, degree of vesical fullness, choice of the parameters. Some difficulties can be linked to the patient's anatomical characteristics (vaginal scar, short or narrow vagina, twisted urethra,...); ways to avoid them are briefly described.