The Application Of The Transperineal Pelvic Floor Ultrasonography In Female Stress Urinary Incontinence

Research backgroundStress urinary incontinence(SUI)is a common disease of women,which seriously reduces the quality of life of patients and is often referred to as "social cancer".At this stage,there are many auxiliary examinations for SUI,including urodynamics,pad test,cystourethrography,magnetic resonance imaging(MRI)and ultrasonography,but urodynamic and cystourethrography are all invasive operations.The procedure of pad test is complicated,and MRI is too expensive to be popularized in clinical.Therefore,the transperineal pelvic floor ultrasonography has become a research hotspot in recent years due to its advantages such as noninvasive,real-time,good repeatability and economy.At present,there are two indexing methods of SUI:subjective and objective.The subjective indexing method is more subjective,and the objective indexing method is the pad test,and the steps are more complicated.Therefore,the application value of transperineal pelvic floor ultrasonography in the indexing of female SUI is gradually being stressed.ObjectiveBy comparing the ultrasonic parameters of anterior compartment between SUI patients and normal women,to explore the application value of transperineal pelvic floor ultrasonography in female SUI,so as to provide more reliable and simple data support for clinical.Materials and methods1 Object of study and groupingA total of 103 women diagnosed with stress urinary incontinence in the pelvic floor reconstruction area of our hospital from June 2016 to June 2019 were selected as the case group,while a total of 56 women without SUI during the normal physical examination in our hospital during the same period were selected as the control group.The two groups of subjects were divided into the non-menopausal group and the menopausal group according to whether menopause to explore the value of transperineal pelvic floor ultrasonography in the diagnosis of female SUI.According to the results of one hour pad test,the case group were divided into mild,moderate and severe groups to explore the application value of transperineal pelvic floor ultrasonography in female SUI indexing.2 Observed indicatorsThe age,height,weight,gravidity,parity and whether menopause of all the subjects were recorded,and calculated the Body Mass Index(BMI).All the subjects underwent the transperineal pelvic floor ultrasonography to measure and record the parameters of the anterior compartment at resting state and maximum Valsalva state:the urethral inclination angle(UIA)at resting state,the bladder neck position at resting state and the bladder neck position at maximum Valsalva state,the posterior urethrovesical angle(PUVA)at maximum Valsalva state,the urethral rotation angle(URA)at maximum Valsalva state,the infundibular bladder neck formation at maximum Valsalva state,and calculated the bladder neck descent(BND).3 Statistical analysisSPSS23.0 software was used for statistical analysis.The measurement data conforming to normal distribution was expressed by x±s.The comparison of measurement data of two independent samples was made by independent sample t-test,the comparison between multiple groups was made by single factor analysis of variance,and the comparison between two groups was made by LSD method.The measurement data that did not conform to the normal distribution was represented by M(P25,p75),the comparison of measurement data of two independent samples was performed by nonparametric Mann Whitney U test,and the comparison between multiple groups was performed by Kruskal Wallis test.The counting data was expressed in percentage(%),and ?2 test was used for comparison(Bonferroni correction test level was used for Pairwise comparison between multiple groups).Receiver operating characteristic(ROC)curves were drawn,and the sensitivity,specificity,and area under the curve(AUC)of each ultrasonic parameter in the diagnosis of SUI were calculated.Cutoff values of each ultrasonic parameter were determined using Medcalc15.0 statistical analysis software.Take ?=0.05 as the test level.Result1.The BMI,infundibular bladder neck formation rate at maximum Valsalva state,URA and BND in non-menopausal SUI patients were all greater than those in un-menopausal normal women.The BMI,gravidity,infundibular bladder neck formation rate at maximum Valsalva state,URA and BND in menopausal SUI patients were all greater than those in menopausal normal women.The gravidity,URA and BND in menopausal SUI patients were all greater than those in un-menopausal SUI patients.The UIA at resting state,PUVA at maximum Valsalva state in non-menopausal SUI patients were all greater than those in menopausal SUI patients.The PUVA at maximum Valsalva state in non-menopausal normal women were greater than those in menopausal normal women,and the differences were statistically significant(P<0.05).2.In the un-menopausal group,when the infundibular bladder neck formation at maximum Valsalva state,URA>64°and BND>27 mm,the sensitivity of diagnosing SUI was 68.57%,37.14%and 54.29%,respectively,the specificity was 80.65%,96.77%and 90.32%,respectively,and the AUC of diagnosing SUI were 0.746,0.653 and 0.761,respectively,when combined analysis of these indexes,the sensitivity,specificity and AUC were 68.57%,87.10%and 0.822,respectively.In the menopausal group,when the infundibular bladder neck formation at maximum Valsalva state,URA>67°and BND>26 mm,the sensitivity of diagnosing SUI was 64.71%,57.35%and 69.12%,respectively,the specificity was 88.00%,96.00%and 80.00%,respectively,and the AUC of diagnosing SUI was 0.764,0.810 and 0.771 respectively,when combined analysis of these indexes,the sensitivity,specificity and AUC were 92.65%,84.00%and 0.932,respectively.3.According to the results of one hour pad test,the case group was divided into 32 mild group,37 moderate group and 34 severe group.The PUVA at maximum Valsalva state in severe SUI patients were greater than those in normal women,mild SUI patients and moderate SUI patients,and the differences were statistically significant(P<0.05).However,there was no significant difference between mild and moderate patients(P>0.05).Conclusion1.The transperineal pelvic floor ultrasonography is of great value in the diagnosis of female SUI,and it can provide reliable and detailed data support for clinical.The combination of the three parameters of the infundibular bladder neck formation at maximum Valsalva state,URA and BND has the highest diagnostic efficiency.2.The ultrasonic diagnostic criteria for non-menopausal and menopausal SUI patients may be different.URA is more significant in the diagnosis of menopausal SUI.3.The application value of transperineal pelvic floor ultrasonograpgy in female SUI indexing is limited.