Clinical Application Of Pelvic Floor Ultrasound In Accurate Diagnosis And Treatment Of Female Mixed Urinary Incontinence

Objective:To explore the value of pelvic floor ultrasound in the diagnosis and evaluation of mixed urinary incontinence(MUI)by observing the ultrasonic manifestations of different types of MUI.To explore the value of pelvic floor ultrasound in evaluating the efficacy and complications of MUI patients who received midurethral sling procedure by observing the ultrasonic manifestations of MUI patients who received midurethral sling procedure.Method:30 female patients with stress-predominant MUI(S-MUI),30 female patients with urge-predominant MUI(U-MUI)and 30 female patients with equal MUI(E-MUI)who visited the Department of Urological Surgery of Jinhua Municipal Central Hospital from January 2020 to October 2022 were selected as experimental groups,and 30 women with normal pelvic floor function were selected as the control group.All subjects were examined by pelvic floor ultrasound.The posterior vesicourethral angle,urethral inclination angle,detrusor muscle thickness in resting state were measured.The posterior vesicourethral angle,urethral inclination angle,urethral rotation angle,bladder neck mobility,levator ani hiatus area during Valsalva maneuver were measured and calculated.The differences of pelvic floor ultrasound parameters among four groups were analyzed and compared.A total of 70 MUI patients who visited the Department of Urological Surgery of Jinhua Municipal Central Hospital and received midurethral sling were selected.Then divided MUI patients into three groups according to the therapeutic effects after operation: cure group(n=49),failure group(n=11)and complication group(n=10).All subjects were examined by pelvic floor ultrasound,the distance from inferior margin of sling to longitudinal smooth muscle(LSM)of urethra,the distance from inferior margin of sling to symphysis pubic(SP),detrusor muscle thickness were measured,and the sling locations were observed.The differences of pelvic floor ultrasound parameters and sling position among three groups were analyzed and compared.Result:In the pelvic floor ultrasonography of 90 patients with MUI and 30 healthy women,the posterior vesicourethral angle during Valsalva maneuver,urethral rotation angle,bladder neck mobility,and levator ani hiatus area in the S-MUI group and the E-MUI group were greater than the control group(P<0.05),the urethral inclination angle during Valsalva maneuver in the S-MUI group was greater than the control group(P<0.05).The detrusor muscle thickness in the U-MUI group was greater than the control group(P<0.05).In the pelvic floor ultrasonography of 70 MUI patients after the midurethral sling procedure,the distance from the inferior margin of sling to LSM in the cure group was greater than the complication group(P<0.05)and smaller than the failure group(P<0.05).The distance from inferior margin of sling to SP in the cure group and the failure group was significantly greater than the complication group(P<0.05).The detrusor muscle thickness in the failure group was greater than the cure group and the complication group(P<0.05).The position of sling relative to urethra in the cure group was significantly different from the failure group(P<0.05).The slings in the cure group were more located relative to external1/2～1/3 of urethra.ROC analysis showed that the areas under the curve of the distance from the inferior margin of sling to LSM and the detrusor muscle thickness for predicting failure were 0.748 and 0.802,the optimal cutoff values were 4.8mm and 2.6mm.ROC analysis showed that the areas under the curve of the distance from inferior margin of sling to LSM and the distance from inferior margin of sling to SP for predicting complication were 0.814 and 0.889,the optimal cutoff values were 3.4mm and 14.3mm.Conclusion:Pelvic floor ultrasound is a good examination method to diagnose MUI,and the pelvic ultrasound manifestations of different types of MUI are different.The measurement of two-dimensional and three-dimensional pelvic floor ultrasound parameters can be used to evaluate the pelvic floor structure of MUI patients,and provide more comprehensive guidance for the clinical diagnosis and treatment of MUI.Pelvic floor ultrasound is also an effective method for postoperative reexamination of MUI patients after midurethral sling procedure.Measuring pelvic floor ultrasound parameters and observing the sling position can provide valuable imaging evidence for postoperative effect analysis and complication evaluation of MUI patients.