Application Of Transperineal Sonography In The Diagnosis Of Female Stress Urinary Incontinence

Objectives Perineal ultrasonography was performed to screen out the best index sign which can diagnose stress urinary incontinence(SUI) and analyze the cutoff points of different levels of SUI, thus exploring the value of the transperineal ultrasonography in female with SUI.Methods 1 255 patients with SUI(111 patients in the mild group, 96 in the moderate group, 48 in the severe one) and 266 control patients without SUI or POP were included from September 2013 to February 2015 in the affiliated Hospital of North China University of Science and Technology. 2 Perineal ultrasonography was performed to measure the position of bladder neck in x axis(X), the position of bladder neck in y axis(Y), posteriorurethra-vesical angle(α), the length of proximal functional urethra(h),the angle of proximal functional urethra and distal functional urethra(β) when at rest and during stress. After taking and storing the images under such conditions, the downmoving distance of bladder neck(ΔDy), the back-moving distance of bladder neck(ΔDx),distance of bladder neck mobility(Mu), the vesical neck rotational angle(θ) were all measured. In addition, observed if infundibular bladder neck would appear during stress.3 Excel was used to establish a database, SPSS17.0 statistical analysis software was used for statistical analysis, all measurement data used by mean±standard deviation( x ±s).Counting information were expressed as percent, their comparison used chi-squared test.The means comparison in several groups used one-way ANOVA.The correlation between two indicators was conducted with Spearman. Analysis of multiple variables was conducted with Logistic regression analysis. Test standard: P<0.05. Receiver operating characters was drew, got AUC, and obtained the best diagnostic threshold values according to the characters.Results 1 When at rest, the location of the bladder neck and urethra in SUI women was closer to bottom and rear of the pelvic than the normal ones. When they transfered from rest to Valsalva, bladder neck and the urethra in normal groug and different leveals of SUI grougs moved to bottom and rear of the pelvic. Although the direction of movement was consistent,the mobility of women with SUI was bigger than the normal ones. 2 Through one-way ANOVA analysis, there were significantly different for age, body mass index, times of pregnancy, times of production(P<0.05). Through χ2analysis, menopause detection rate was statistically significant(P<0.05). 3 There were significantly different for X1, Y1, α1, h1 and X2, Y2, α2, β2 among the control group, mild SUI group, moderate SUI group and severe one(P<0.05). It showed the location of bladder neck in women with SUI was closer to bottom and rear of the pelvic, the vesical neck rotational angle was bigger,the length of proximal functional urethra was shorter. It was more obvious in serious patients. There were significantly different for Mu, θ among those four groups(P<0.05). It showed distance of bladder neck mobility(Mu) and the vesical neck rotational angle(θ) was bigger in SUI group. It was more obvious in serious patients. 4 Spearman correlation analysisis was carried out to analyze the relationship between SUI and different index signs. SUI had positive correlation with age, BMI, times of pregnancy, times of production,menopause, X1, α1, β1, X2, α2, β2, ΔDx, ΔDy, Mu, θ and had negative correlation with Y1,h1, Y2, h2. 5 θ had the most important meaning to diagnose SUI. It was the index sign that could better response the anatomic change of the bladder neck and the urethra. 6 θ had better sensitivity, specificity, positive predictive value for diagnosing different leveals of SUI, so θ was the index sign that could diagnose different leveals of SUI.Conclusions 1 The position of bladder neck, posteriorurethra-vesical angle, distance of bladder neck mobility and the vesical neck rotational angle are found to be significantly different in women with different levels of SUI and the normal ones. 2 θ has the most important meaning to diagnose SUI. 3 It is of great value when θ are 21.5°,27.5°,37.5°to diagnose SUI, moderate, severe SUI and severe SUI. 4 Perineal ultrasonography plays an important role in diagnosing patients with SUI.