A Comparative Study Of Pelvic Floor Ultrasonography And Urodynamic Examination For The Evaluation Of Female Stress Urinary Incontinence

Objective:To compare and analyze the clinical data,urodynamic examination and pelvic floor ultrasonography results between normal women and female patients with stress urinary incontinence(SUI)and different types of SUI(according to the abdominal pressure leak point pressure as the classification standard),and to explore the clinical value of urodynamic examination and pelvic floor ultrasonography examination in the evaluation of female stress urinary incontinence,in order to provide more reliable basis for the clinical diagnosis of SUI by combining anatomical examination and functional examination.Methods:From January 2019 to January 2021,32 female SUI patients in the Second Affiliated Hospital of Kunming Medical University and 10 female healthy subjects were retrospectively analyzed,a total of 42 patients with complete pelvic floor ultrasonography and urodynamic examination data.The case group consisted of patients who met the diagnostic criteria of the International Continence Society after clinical assessment and urodynamic examination.According to the abdominal leak point pressure(ALPP),the patients were divided into three groups:type Ⅰ groud:ALPP≥90 cmH2O,11 cases;type Ⅱ group:60cmH2O<ALPP<90cmH2O,14 cases;type Ⅲ group:ALPP<60cmH2O,7 cases.The control group were subjects who visited the clinic for non-lower urinary tract diseases or healthy physical examination in the same period.All subjects met the inclusion and exclusion criteria.General clinical data such as age.height,weight,BMI,gravidity,parity,menopause status and pelvic floor ultrasonography and urodynamic examination findings were collected from all patients.SPSS26.0tatistical software was used to analyze the differences in the general data of patients in each group,and the parameters of pelvic floor ultrasonography and urodynamic examination that have diagnostic value among the control group and the case group,and the different types of SUI group.ROC curve was drawn,and the critical values and diagnostic efficiency of each parameter and combined parameters were calculated.Results:There were no statistical differences in age,BMI,gravidity,parity and menopause among the control group,type Ⅰ group,type Ⅱ group and type Ⅲ group(P>0.05).The urodynamics parameters(except ALPP)of the control group and the case group during storage:there was no significant difference in the first desire to void,normal desire to void,urgency desire to void,maximum cystometric capacity and bladder compliance.The maximum flow rate was greater in the Type Ⅲ group than that in the control group during urination(Type Ⅲ group:35.07±10.69,control group:21.71±7.03,P=0.035),and the detrusor pressure at maximum flow rate was lower than that in the control group(type Ⅲ group:13.00±5.72,control group:23.60 ±9.70,P=0.046).There was no notable difference in the average urinary flow rate and residual urine between each of the two groups(P>0.05).There was no statistical difference between the control group and the case group at rest state for each parameter of pelvic floor ultrasonography:bladder neck position,retrovesical angle,detrusor thickness,residual urine volume,the incidence of funnelization of intraurethral orifice.at maximal Valsalva state,the mobility of bladder neck,retrovesical angle,the incidence of funnelization of intraurethral orifice and increased urethral rotation angle(>45°as increased)in the case group were higher than those in the control group,and the differences were statistically significant(P<0.05).The bladder neck position in the case group(-3.97±6.69,negative value indicated below the inferior edge of pubic symphysis)was smaller than that in the control group(5.11±3.68),and the difference was statistically significant(P<0.001).There was no significant difference in levator hiatus area and levator injury rate between the two group(P<0.05).There was no significant difference in pelvic floor ultrasonography parameters among different types in the case group(P>0.05).Logistic regression was used to analyze the predictive probability of the four combined diagnoses of bladder neck mobility,urethral rotation angle,retrovesical angle,and the incidence of funnelization of intraurethral orifice at maximal Valsalva state,and further plotted the ROC curves for each parameter and the combined parameters.The sensitivity of SUI diagnosis was 68.8%,68.8%,68.8%,87.5%,respectively,the specificity was 100.0%,90.0%,90.0%,70.0%,respectively,and the area under curve(AUC)was 0.844、0.794、0.845、0.847,respectively.The sensitivity of the four combined parameters was 90.8%and the specificity 100%,with an AUC of 0.975.Conclusion:1.The parameters of urodynamic during storage(except ALPP)were not significantly different between patients with simple SUI and normal women,which is consistent with the characteristics of simple SUI.The purpose of exclusion with lower urinary tract diseases was achieved by verifying whether the bladder capacity,sensation,stability and compliance were normal.2.According to ALPP classification,patients with type Ⅲ SUI have significant alterations in urodynamic parameters during urination,indicating a significant reduction in urethral sphincter closure function.3.Pelvic floor ultrasonography provides a good visualisation of the pelvic floor tissues.There is no significant difference between normal women and SUI patients at rest,and at maximal Valsalva state there is a significant increase in vesicourethral mobility in SUI patients due to increased abdominal pressure and relaxation of the pelvic floor tissues.4.at maximal Valsalva state,bladder neck mobility,funnelization of intraurethral orifice,retrovesical angle and urethral rotation angle have high diagnostic value for SUI,which can be used as an important supplementary diagnostic basis.5.Pelvic floor ultrasonography has no definite value in assessing the typing of SUI.