What is the role of imaging studies in the workup of urinary incontinence?

Updated: Mar 19, 2019
  • Author: Sandip P Vasavada, MD; Chief Editor: Edward David Kim, MD, FACS  more...
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Answer

In the ED setting, the following imaging studies are helpful for delineating serious causes of urinary incontinence, when appropriate [30, 50, 24] :

  • Spinal MRI should be performed for ruling out cord compression, cauda equina, or spinal abscess if symptoms support the diagnosis

  • Ultrasonography allows for evaluation of hydronephrosis, hydroureter, and urinary tract stones. Ultrasonography is noninvasive, widely available, and cost-effective

  • CT scans with or without contrast for renal calculi or pyelonephritis

Additional imaging studies that can aid in delineating the characteristics of urinary incontinence but are usually not ordered from an emergency perspective include the following:

  • Fluoroscopy and video urodynamics determines bladder, intra-abdominal, and urethral pressures. It is often a valuable tool in the evaluation of complex stress incontinence

  • Cystourethrography is a useful diagnostic adjunct in suspected cases of urinary tract fistulas

  • Intravenous pyelography (IVP) may differentiate between ureterovesical fistula and vesicovaginal fistula

  • Positive-pressure urethrogram is most useful for diagnosing urethral diverticulum

  • MRI is the most accurate technique for visualizing pelvic floor defects


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