| Stress urinary incontinence(SUI)is one of the common diseases of female pelvic floor dysfunction.The incidence of SUI in Chinese women is about 20%.The prevalence rate of postpartum SUI increases year by year,so it is necessary to build an early warning model of postpartum SUI to identify high-risk groups and manage them at different levels.At present,pregnancy and delivery are important risk factors of SUI.The loss of urethral sphincter function and increased urethral mobility are important causes of SUI.Pelvic floor ultrasound evaluated urethral activity by measuring bladder neck descending distance(BND),urethral rotation angle(URA)and posterior bladder angle(PUA).The formation of internal urethral funnel was observed to evaluate the existence of sphincter function defect.In recent years,it is found that high motion of middle urethra is a new theory to explain SUI by using urethral motion curve to evaluate segmental urethral motion.But there is no simple method to measure the range motion of middle urethra.Objective:(1)To explore the value of routine two-dimensional ultrasound parameters in the diagnosis and prediction of SUI.(2)To explore the feasibility of using urethral midpoint displacement parameters to evaluate the range of motion of middle urethra.(3)To establish risk prediction model and score model of postpartum SUI according to clinical factors and ultrasound parameters.Methods:Women who delivered in the affiliated Hospital of Chengde Medical College from November 2021 to December 2022 were selected for postpartum reexamination.According to the occurrence of SUI,they were divided into SUI group and control group.(1)To fill the"Postpartum pelvic floor structure and function questionnaire"for clinical information collection,recording general data and pregnancy history;(2)Perform pelvic floor ultrasound examination:recording the formation of urethral funnel and measuring BND,URA and PUA.Taking the midpoint of the posterior edge of pubic symphysis as the origin(0,0)to establish the coordinate axis,using the continuous recording function of ultrasound to measure the urethral length many times to find the urethral midpoint.The urethral midpoint coordinates of resting state and maximum Valsalva state(1,1)、and(2,2)were measured respectively.The degree of movement?xand?y were calculated,and the urethral midpoint displacement vector Q was calculated by the formula Q=?x~2+?y~2.(3)To compare the differences of the parameters between the SUI group and the control group,we draw the working characteristic(receiver operating characteristic curve,ROC)curve of the subjects.Then we evaluate the diagnostic efficacy of each parameter to SUI,carry on the univariate and multivariate Logistic regression analysis of each parameter.Finally we select the meaningful parameters to establish the prediction model and risk score model,then evaluate the effect of the model.Results:(1)According to the inclusion and exclusion criteria,a total of 125 patients were included,including 53 patients in the SUI group(42.4%)and 72 patients in the control group(57.6%).There was significant difference in BMI and delivery mode between the two groups(P<0.05),but there was no significant difference in age,pregnancy,parity and fetal birth(P>0.05).ROC curve showed that the area under the curve of BMI and natural delivery(area under the curve,AUC)were 0.64 and 0.68 respectively.(2)Conventional two-dimensional ultrasound parameters of trans-perineal pelvic floor ultrasound:30 patients in the SUI group(58.9%)had urethral funnel and 13 patients in the control group(24.1%)had urethral funnel,and there was significant difference between the two groups(P<0.05).BND,URA,resting PUA~1and Valsalva state PUA~2 in the SUI group were significantly higher than those in the control group(P<0.05).ROC curve showed that the urethral funnel,BND,URA,PUA1,PUA2 and AUC were 0.69,0.65,0.72,0.63 and 0.69,respectively.(3)The parameters of urethral midpoint displacement by trans-perineal pelvic floor ultrasound:there was no significant difference in the displacement parameter?xbetween the SUI group and the control group(P>0.05),but the displacement parameters?yand vector Q in the SUI group were significantly higher than those in the control group(P<0.05).The AUC of ROC curve parameter和?y and vector Q are 0.71 and 0.77,which can be used to diagnose SUI.The sensitivity and specificity of vector Q to diagnose postpartum SUI with 2.57cm~2 cutoff value are 67.9%and 86.1%.(4)ROC curve analysis showed that there was no significant difference in urethral midpoint displacement parameter(AUC)between和?yand BND in diagnosis of SUI(P>0.05),but there was significant difference in AUC between vector Q and BND in diagnosis of SUI(P<0.05).(5)Logistic regression analysis showed that displacement vector Q(X1),urethral funnel(X2),BMI(X3)and delivery mode(X4)were independent risk factors of SUI.The multivariate Logistic regression equation Logit(P)=-4.907+3.301*X1+7.154*X2+4.078*X3+6.334*X4 was constructed.The AUC of the prediction model was 0.88,and the sensitivity and specificity were 83.02%and 80.56%,(6)The SUI risk scoring model was constructed by using theβvalue of multi-factor Logistic regression analysis to score the screened parameters.The total score of the model was 0～6.The ROC curve showed that the AUC of the scoring model was 0.87.The sensitivity and specificity of>2 cutoff value are75.5%and 84.7%.The model predicts the effectiveness of SUI.Conclusions:(1)Conventional two-dimensional ultrasound parameters BND,URA and PUA can only diagnose SUI,not a risk factor for SUI,while urethral funnel is a risk factor for SUI incontinence.It is helpful to predict SUI clinically.(2)Urethral midpoint displacement parameter?y and vector Q can diagnose SUI and are risk factors for SUI.The vector Q is more effective than BND in diagnosing urethral mobility,which is of great significance in the research and diagnosis of SUI.(3)Constructing a scoring model based on clinical risk factors and ultrasonic urethral parameters provides a simple method for clinical screening of high-risk population. |
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