Clinical Application Of Transperineal Sonography In Evaluating Pelvic Floor Structure In Patients With Stress Urinary Incontinence

Objective: Stress urinary incontinence(SUI),as a kind of female pelvic floor dysfunction disease,its occurrence and development are closely related to the changes of pelvic floor structure and function.Transperineal ultrasound can observe the structure and function of pelvic floor in real-time,effectively and dynamically,without changing the normal anatomical structure around vagina and urethra,and has the advantages of simple operation,non-invasive,non-radiation,and economic benefits.In this study,the advantages of ultrasound in pelvic floor structure imaging were utilized to analyze the structural changes of the pelvic floor in SUI patients with or without pelvic organ prolapse(POP)by perineal ultrasound imaging,and discuss the diagnostic value of ultrasound.Methods:Patients diagnosed as SUI in our hospital between January 2019 and June 2020 were selected into the case group,and patients excluding the diagnosis of SUI in the same period were selected into the control group.The diagnosis of POP was excluded from both groups.Patients in each group were performed transperineal ultrasound examination.The ultrasonic parameters were compared,and the diagnostic value to SUI of each ultrasonic parameter was analyzed by ROC curve.In another design,patients diagnosed as SUI combined with POP in our hospital between January 2019 and June2020 were selected as the case group,and patients of the same age diagnosed with SUI without POP in the same period were selected as the control group.Patients in case group were further divided into three groups according to the type of prolapse: cystocele,uterine prolapse,and cystocele combined with uterine prolapse.Ultrasound parameters were further compared between patients with or without POP,so as to analyze changes in pelvic floor structure of SUI combined with POP.Results:Compared with the patients without SUI,bladder neck symphyseal distance,bladder lowest point symphyseal distance,bladder neck descent,retrovesical angle,the rate of bladder neck funnel formation,and levator hiatus area in the case group at Valsalva manoeuvre were significantly higher(P<0.05).After further dividing the case group into the mild,moderate,and severe group according to the severity of SUI,there was no significant difference in ultrasonic parameters among the three groups.ROC curve analysis showed that all the above ultrasonic parameters with significant differences between the case and the control group were of value in the diagnosis of SUI(P<0.05).The sensitivity and specificity value of combined parameters in diagnosing SUI were 70.09% and 96.61% respectively.The diagnostic value of combined parameters was greater than that of single parameter.In another design,compared with SUI patients without prolapse,bladder neck symphyseal distance,bladder lowest point symphyseal distance,bladder neck descent,levator hiatus area,and levator ani muscle injury rate of patients in the case group were significantly higher(P<0.05).In addition,the rates of open retrovesical angle and bladder neck funnel formation were reduced significantly in patients combined with POP(P<0.05).Logistic regression analysis showed that moderate and severe POP could affect the retrovesical angle and bladder neck funnel formation in SUI patients(P<0.05).Conclusion:Transperineal ultrasound can accurately and intuitively observe the supporting structures around the bladder neck and urethra.The ultrasonic parameters are relevant to the occurrence of SUI,but no to the severity.Ultrasound examination can provide important imaging basis for clinical diagnosis of SUI.In patients with SUI combined with POP,the pelvic floor structure was seriously damaged,especially moderate and severe POP had a great impact on the peri-urethral anatomy.The evaluation of SUI in such patients by transperineal ultrasound was also affected.