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Shi L, Zhao Y, Li W, Chen L, Shen W, Zhai L. Evaluation of pelvic structural abnormalities in primiparous women with stress urinary incontinence. Int Urogynecol J 2024; 35:369-380. [PMID: 37966496 DOI: 10.1007/s00192-023-05675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 10/08/2023] [Indexed: 11/16/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the morphological characteristics of pelvic floor structure specific to de novo stress urinary incontinence (SUI) in primiparous women using three-dimensional (3D) reconstruction fusion technology based on static MRI combined with dynamic MRI. METHODS Eighty-one primiparous women after the first vaginal delivery were studied, 40 with SUI and 41 without SUI. 3D reconstruction models based on static MRI were used to describe the anatomical abnormalities of pelvic floor tissues. Dynamic MRI was used to describe segmental activities of the urethra and vagina. The relationship between the morphometry and postpartum SUI was evaluated by logistic regression analysis and receiver operator characteristic curve. RESULTS The differences in the distance from the bladder neck to the pubic symphysis (BSD), the angle between the posterior wall of the urethra and the anterior wall of the vagina, the width of the distal region of the vagina, urethral length, urethral compression muscle volume (CUV), and pubovisceral muscle volume, puborectal muscle volume, were measured, and except for the extremity of the anterior urethral wall, the total displacements (TDs) of the other sites between the two groups were statistically significant (p < 0.05). Logistic regression analysis showed that the BSD decreased, the CUV decreased, the TDs of the first site and the eighth site increment correlated significantly with postpartum SUI occurrence (p < 0.05). CONCLUSIONS 3D reconstruction fusion technology provides an important support for a precise assessment of the pelvic floor dysfunction. The BSD, CUV, and iliococcygeus muscle volume have certain values in predicting de novo SUI after first vaginal birth.
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Affiliation(s)
- Li Shi
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Yujiao Zhao
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China
| | - Weijun Li
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China
| | - Lihua Chen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China
| | - Wen Shen
- Department of Radiology, Tianjin First Central Hospital, School of Medicine, Nankai University, Fukang Road No. 24, Nankai District, Tianjin, 300192, China.
| | - Lidong Zhai
- Department of Anatomy and Histology, School of Basic Medical Sciences, Tianjin Medical University, Tianjin, 300070, China.
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Pająk PM, Wlaźlak E, Surkont G, Kalinka J. An assessment of the relationship between urethral hypermobility as measured by ultrasound and the symptoms of stress urinary incontinence in primiparous women 9-18 months postpartum. J Ultrason 2024; 24:20240010. [PMID: 38496788 PMCID: PMC10940277 DOI: 10.15557/jou.2024.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 02/29/2024] [Accepted: 07/25/2023] [Indexed: 03/19/2024] Open
Abstract
Aim The aim of the study was to estimate the relationship between bladder neck hypermobility as assessed by ultrasound and the occurrence of stress urinary incontinence as measured with the UDI-6 questionnaire in primiparous women 9-18 months postpartum. Materials and methods The study included 100 women 9-18 months after their first delivery, 19% of whom (study group) presented with urethral hypermobility. Ultrasound was used to determine the position and mobility of the bladder neck in order to assess the urethral hypermobility. A vector of ≥15 mm was defined as urethral hypermobility. Symptoms of stress urinary incontinence were assessed using question 3 of the UDI-6 questionnaire, in which the presence of symptoms was defined as a response rated from 1 to 4. Results We demonstrated a statistically significant relationship between urethral hypermobility and the symptoms of stress urinary incontinence with a statistical significance level of p <0.002. Conclusions Stress urinary incontinence is a common disorder in women, the pathophysiology of which is not fully understood. It has adverse effects on the quality of life, perception of one's own body and sexual function. Impairment of urethral fixation may play an important role in the pathophysiology of this common form of urinary incontinence. The study showed that urethral hypermobility, as assessed by ultrasound, contributes to stress urinary incontinence, as measured with the UDI-6 score. Although stress urinary incontinence is a multifactorial disorder influenced by anatomical changes and congenital anatomical features, it is easily diagnosed. Suburethral slings are an effective surgical technique; however, the incidence of postoperative voiding dysfunction or recurrent stress urinary incontinence is 10-20%. Therefore, an assessment of anatomical changes in stress urinary incontinence may help individualize the surgical strategy.
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Affiliation(s)
- Paulina Maria Pająk
- Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Edyta Wlaźlak
- Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Surkont
- Department of Operative Gynecology and Gynecologic Oncology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
| | - Jarosław Kalinka
- Department of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, Lodz, Poland
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Zhao B, Wen L, Liu D, Huang S. Visualized Urethral Mobility Profile During Urine Leakage in Supine and Standing Positions. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2023; 44:e158-e163. [PMID: 35168283 DOI: 10.1055/a-1700-2862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To describe the urethral course and position during urine leakage based on the visualized urethral mobility profile (UMP) and to explore the differences between supine and standing positions. METHOD This was a prospective study of 100 women with SUI and 100 control women who underwent a cough stress test (CST) with transperineal ultrasound (TPUS) in supine and standing positions. In the mid-sagittal plane, the UMP software automatically placed six equidistant points from the bladder neck (point 1) to the external urethral meatus (point 6). It determined the x and y coordinates of the points relative to the symphysis pubis. The distance between the points and symphysis pubis (dist. 1 to 6) was calculated using the formula SQRT (x2 + y2). The visualized UMP was created by reproducing the six points on a bitmap. RESULTS Valid UMP data of 78 control women and 90 women with SUI were analyzed. In the two positions, distances 1 to 6 were significantly greater in the SUI group than the continent group (all p < 0.05). During Valsalva, the distance between the mid-urethra (dist. 3 and 4) and the symphysis was significantly increased (all p < 0.001) in the SUI group. The visualized UMP showed a similar upper-urethral course in the two groups. The gap between the mid-urethra (points 3 and 4) and symphysis was wider in the SUI group. CONCLUSION The visualized UMP in supine and standing positions showed no difference in the bladder neck and upper urethral stability between incontinent and continent women, but mid-urethral stability was weaker in SUI.
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Affiliation(s)
- Baihua Zhao
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Lieming Wen
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Dan Liu
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
| | - Shanya Huang
- Ultrasound diagnosis, Second Xiangya Hospital, Central South University, Changsha, China
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Chen Y, Peng L, Liu M, Shen H, Luo D. Diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI): a systematic review and meta-analysis. World J Urol 2023; 41:687-693. [PMID: 36598556 DOI: 10.1007/s00345-022-04264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/12/2022] [Indexed: 01/05/2023] Open
Abstract
PURPOSE We aimed to analyze the diagnostic value of transperineal ultrasound in patients with stress urinary incontinence (SUI) using evidence-based methods. METHODS A comprehensive search of the studies on the diagnosis of SUI by transperineal ultrasound in PubMed, EMBASE, MEDLINE, Cochrane library, Medicine, Web of Science, and clinicaltrials.gov databases on August 1, 2022. Studies were included if they met the inclusion criteria and were evaluated by different quality evaluation methods according to study types. Various ultrasound parameters were collected and counted to analyze and judge the diagnostic value of transperineal ultrasound in SUI patients. RESULTS A total of 13 studies with 1563 participants were finally included. The combined statistics showed no significant difference in age and parity among the included patients, and the BMI of the SUI group was slightly higher than that of the normal population (MD 1.20, 95%CI 0.68-1.72). The results indicated that compared with the normal population, the α angle (MD 15.56, 95%CI 9.93-21.90), β angle (at rest: MD 10.02 mm, 95%CI 1.95-18.09; at Valsalva: MD 22.40 mm, 95%CI 13.79-31.01), bladder neck descent (MD 6.82 mm, 95%CI 4.49-9.14), area of hiatus (MD 2.83 cm2, 95%CI 0.71-4.94) and bladder neck funneling (RR 4.71, 95%CI 1.08-20.62) of SUI patients were significantly different, which illustrated the potential value of transperineal ultrasound in diagnosing SUI. CONCLUSION Evidence-based medicine was applied to statistically analyze published articles on the diagnostic value of transperineal ultrasound in SUI. The results suggested that transperineal ultrasound had application value in the diagnosis of SUI and had the potential to become a routine examination method to assist clinical decision-making.
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Affiliation(s)
- Yuanzhuo Chen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Liao Peng
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Mengzhu Liu
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Hong Shen
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China
| | - Deyi Luo
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, Sichuan, 610041, People's Republic of China.
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Zhao B, Wen L, Liu D, Huang S. The Visualized Urethral Mobility Profile in Stress Urinary Incontinence Described by Four-Dimensional Transperineal Ultrasound. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1439-1445. [PMID: 34515354 DOI: 10.1002/jum.15828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/25/2021] [Accepted: 08/29/2021] [Indexed: 05/17/2023]
Abstract
OBJECTIVES To describe the urethral mobility during urine leaking in stress urinary incontinence (SUI) by transperineal ultrasound (TPUS) with urethral mobility profile (UMP) analysis. METHODS This was a prospective study of 380 women who had a cough stress test (CST) with TPUS. UMP software automatically placed six equidistant points from the bladder neck (Point 1) to the external urethral meatus (Point 6) and determined their x and y coordinates relative to the symphysis pubis. Urethral mobility vector of Points 1-6 (Vectors 1-6) and the distance between the six points and the symphysis (Dist. 1-6) were calculated and compared between the two groups. The visualized UMP was created by reproducing the positions of the six points at rest and on Valsalva. RESULTS Valid data of 188 women with SUI and 174 continent women were analyzed. The mean age of all 362 women was 49.3 years. Mean body mass index in the SUI group was significantly increased (23.8 vs 22.2 kg/m2 , P < .001). During CST, Vectors 1-6 and Dist. 2-6 were significantly increased (all P < .005) in the SUI group. The UMP showed the mid-urethral rotated down around the symphysis pubis. The upper urethral profile in the two groups was similar. But the gap between the mid-urethra and the symphysis was wider in the SUI group. CONCLUSIONS The visualized UMP illustrated the mid-urethral hypermobility in SUI by showing a wider gap due to the unstable connection between the mid-urethra and the symphysis pubis.
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Affiliation(s)
- Baihua Zhao
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lieming Wen
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | - Shanya Huang
- Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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