Pizzoferrato Anne-Cécile, Nyangoh Timoh Krystel, Bader Georges, Fort Julie, Fritel Xavier, Fauconnier Arnaud
Research Unit EA7285, Risk and Safety in Clinical Medicine for Women and Perinatal Health, Université Versailles St-Quentin, Montigny-le-Bretonneux, France.
Department of Gynaecology and Obstetrics, University Hospital of Caen, Avenue Côte de Nacre, 14000, Caen, France.
Int Urogynecol J. 2019 Sep;30(9):1551-1557. doi: 10.1007/s00192-019-03933-w. Epub 2019 Apr 6.
Ultrasound measurement of urethral mobility is an attractive approach to directly visualize bladder neck descent (BND) during stress. BND assessed by transperineal ultrasound appears to be associated with stress urinary incontinence (SUI) severity. This study evaluated the inter- and intra-observer reliability of ultrasound BND measurement and its correlation with clinical examination.
We included 50 women from the multicenter randomized 3PN study ("Prenatal Perineal Prevention"). BND was measured by two operators either during pregnancy (at 20 weeks of gestation) or 2 months after delivery. Two measurements were taken by each operator. Intra-class coefficient correlations were used for analysis. Urethral mobility was clinically assessed by measuring the point Aa of the POP-Q classification during maximum strain (Valsalva maneuver) with an empty bladder.
Ultrasound analysis showed high intra-observer reliability in the overall population: intraclass correlation coefficients (ICC) = 0.75 (0.59-0.85) and 0.73 (0.55-0.84) for each operator. Intra-observer agreements were considered moderate to high in the post- and antepartum groups. Inter-observer agreements were moderate in the antepartum period [ICC = 0.58 (0.26-0.78) for the first measurement and 0.68 (0.42-0.84) for the second] but low in the postpartum period [ICC = 0.15 (0.10-0.41) and 0.21 (0.10-0.58)]. Correlations between ultrasound and clinical measurements were considered low to moderate (Spearman coefficient, rho = 0.34 and 0.50 for post- and antepartum periods, respectively).
Inter-observer reliability of ultrasound urethral mobility measurements by the transperineal route is moderate antepartum and low postpartum. The correlation with point Aa is low to moderate.
超声测量尿道活动度是一种在应力状态下直接可视化膀胱颈下移（BND）的有吸引力的方法。经会阴超声评估的BND似乎与压力性尿失禁（SUI）的严重程度相关。本研究评估了超声测量BND的观察者间和观察者内可靠性及其与临床检查的相关性。
我们纳入了来自多中心随机3PN研究（“产前会阴预防”）的50名女性。由两名操作人员在孕期（妊娠20周时）或产后2个月测量BND。每位操作人员进行两次测量。采用组内相关系数进行分析。通过在膀胱空虚状态下最大用力（瓦尔萨尔瓦动作）时测量POP-Q分类的Aa点对尿道活动度进行临床评估。
超声分析显示总体人群中观察者内可靠性较高：每位操作人员的组内相关系数（ICC）分别为0.75（0.59 - 0.85）和0.73（0.55 - 0.84）。产后和产前组的观察者内一致性被认为是中度到高度。产前观察者间一致性为中度[第一次测量的ICC = 0.58（0.26 - 0.78），第二次测量的ICC = 0.68（0.42 - 0.84）]，但产后为低度[ICC = 0.15（0.10 - 0.41）和0.21（0.10 - 0.58）]。超声与临床测量之间的相关性被认为是低度到中度（斯皮尔曼系数，产后和产前时期的rho分别为0.34和0.50）。
经会阴途径超声测量尿道活动度的观察者间可靠性产前为中度，产后为低度。与Aa点的相关性为低度到中度。
