Application Of Transperineal Pelvic Floor Ultrasound Combined With Elastography Of Levator Ani Muscle In Stress Urinary Incontinence

Objective:(1)To investigate the value of conventional two-dimensional ultrasound parameters with transperineal pelvic floor in the diagnosis of stress urinary incontinence(SUI).(2)To investigate the value of elastic modulus of levator ani muscle of shear wave elastography(SWE)in the diagnosis of SUI.Methods: Thirty-two patients with stress urinary incontinence from October 2019 to August 2020 in the Affiliated Hospital of Qingdao University as the SUI group which middle-aged and elderly women with involuntary urinary leakage,clinical examination and urodynamics proved to be SUI were selected,in addition,thirty-four healthy women were selected as the control group,for clinical information collection,detail the subject’s general information,including age,body weight,delivery pattern,history of menopause,long-term constipation(≥six months),history of hypertension.And then a conventional two-dimensional ultrasound and SWE examination of the transperineal pelvic floor were began,to obtain the maximum value(Emax)and the mean value(Emean)modulus of elasticity at rest and the maximum Valsalva of the levator ani muscle,and the change of the maximum value(△Emax)and the change of the mean value(△Emean)of the elasticity modulus of the levator ani muscle at the maximum Valsalva.The receiver operating characteristic curve(ROC)is constructed and the area under curve(AUC)of the Emax、Emean and △Emax、△Emean of elastic modulus at the maximum Valsalva is obtained to evaluate the diagnostic efficiency in the SUI.Single factor analysis was used to screen statistically significant independent variables(inclusion criteria: P<0.05,exclusion criteria: P>0.10)into binary Logistic regression analysis to evaluate clinical variables,pelvic floor conventional two-dimensional ultrasound parameters and elastic modulus values in diagnosis of the SUI.Results:(1)In the conventional two-dimensional ultrasound examination,there was significant difference in bladder neck descent between the SUI group(2.64±0.42cm)and the control group(1.60±0.32cm)(t=-11.3062,p<0.001);The SUI group of(14/32)43.75%had significantly different urethral funnel formation than the control group of(2/34)5.88%(χ~2=10.892,p=0.001);The SUI group on the left and right levator ani muscle thickness(0.95±0.09cm/0.95±0.10cm)was significantly lower in the control group(1.12±0.15cm/1.10±0.17cm),differences were statistically significant(left t’=5.571,right t’=4.442,All P<0.001).(2)The results of the SWE examination: in the SUI group and control group of the levator ani muscle and attached under a pubic branch or belly and caudal,the elastic modulus value of the maximum Valsalva are significantly greater than the resting state,and the levator ani muscle △Emax and △Emean of the SUI group than the control group decreased significantly,the difference had statistical significance(All P<0.05).at the maximum Valsalva state,the modulus of elasticity is significantly higher than the resting state,The difference △Emax and △Emean of elastic modulus of the levator ani muscle in the SUI group were significantly lower than those in the control group,both differences were statistically significant(P<0.05).The ROC curves of Emax,Emean and △Emax,△Emean at maximum Valsalva state,the AUC were0.691,0.705,0.798,0.807,The Jordan index was 0.395,0.419,0.543,0.574,the △Emax and the △Emean were better than the Emax and the Emean in evaluation the SUI.The sensitivity and specificity of △Emax=21.40 k Pa were 82.4% and 71.9% respectively,The sensitivity and specificity of △Emean=18.80 k Pa as diagnostic threshold were 82.4% and75.0%,The sensitivity and specificity of Emax=81.45 k Pa were 67.6% and 71.9%respectively,The sensitivity and specificity of Emean=69.05 k Pa were 69.4% and 62.5%respectively.(3)The results of the single factor analysis show that,menopause,urethral funnel formation,increased bladder neck descent,and thickness of levator ani muscle are the most valuable parameters of the SUI diagnosis.The sensitivity and specificity of△Emean as diagnostic threshold were higher than △Emax and it was incorporated into Logistic binary regression analysis.The results showed that urethral funnel formation,increased bladder neck descent and △Emean of the levator ani muscle were independent risk factors(P =0.024,0.017,0.004).Conclusion :(1)The increase of bladder neck descent,the formation of urethral funnel are important indexes and good repeatability in the diagnosis SUI of the transperineal pelvic floor with the conventional two-dimensional ultrasound examination.(2)The SWE technology can quantitatively evaluate the elasticity of levator ani muscle through the rest and the maximum Valsalva states,determine the the diff,erent degrees of damage,and have important application value in the diagnosis of SUI,provide important imaging support for clinical diagnosis and treatment of the women,and advoiding some unnecessary invasive examination.(3)Binary Logistic regression analysis can evaluate the value of clinical variables,the conventional two-dimensional ultrasound parameters and the elastic modulus of the levator ani muscle in the diagnosis of SUI.