Department of Ultrasound, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Rd, Tianhe District, Guangzhou, Guangdong Province, China, 510630.
Department of Ultrasound, The First People's Hospital of Foshan, Foshan, Guangdong Province, China.
AJR Am J Roentgenol. 2019 Nov;213(5):1163-1169. doi: 10.2214/AJR.18.20893. Epub 2019 Aug 6.
The purpose of this study is to determine the value of translabial real-time 3D ultrasound for predicting stress urinary incontinence (SUI). From December 2012 to August 2016, women with or without SUI diagnosed by urologists via urodynamics were prospectively recruited. All subjects underwent translabial real-time 3D ultrasound at one institution. Volume data were analyzed offline by a radiologist who was blinded to the diagnosis and who evaluated the bladder neck position on maximal Valsalva maneuver, the levator hiatus area on maximum Valsalva maneuver, bladder neck descent, and the urethral rotation angle. Combinations of two, three, and four parameters were analyzed using Fisher linear discriminant analysis. ROC curves were constructed to determine the optimal cutoff values of the four parameters and all combinations of parameters to predict SUI. A total of 321 women with SUI (mean [± SD] age, 35 ± 11 years) and 90 women without SUI (mean age, 31 ± 8 years) were included. Only 337 women were included in the final study, to eliminate the confounder of age. The cutoff values for the bladder neck position on maximal Valsalva maneuver, the levator hiatus area on maximum Valsalva maneuver, bladder neck descent, and the urethral rotation angle as parameters predicting SUI were 1 mm, 19 cm, 24 mm, and 45°, respectively. For all combinations of parameters, the negative predictive values were more than 90%, although none of the combinations had a sensitivity higher than 70%. The specificities were approximately 95% when three or four parameters were included. The positive predictive value of the combinations ranged from 49.2% to 84.8%. Translabial real-time 3D ultrasound is insufficient for predicting SUI, but it can be used to identify women without the condition.
本研究旨在探讨经阴道实时三维超声在预测压力性尿失禁（SUI）中的价值。 2012 年 12 月至 2016 年 8 月，前瞻性招募经泌尿科医生尿动力学诊断为 SUI 或无 SUI 的女性。所有患者均在一家机构行经阴道实时三维超声检查。由一名对诊断结果不知情的放射科医生对容积数据进行离线分析，评估最大 Valsalva 动作时膀胱颈位置、最大 Valsalva 动作时肛提肌裂孔面积、膀胱颈下降程度和尿道旋转角度。使用 Fisher 线性判别分析分析两个、三个和四个参数的组合。构建 ROC 曲线以确定四个参数和所有参数组合的最佳截断值，以预测 SUI。 共纳入 321 例 SUI 患者（平均年龄[±标准差]，35 ± 11 岁）和 90 例无 SUI 患者（平均年龄，31 ± 8 岁）。由于年龄的混杂因素，最终研究仅纳入 337 例患者。最大 Valsalva 动作时膀胱颈位置、最大 Valsalva 动作时肛提肌裂孔面积、膀胱颈下降程度和尿道旋转角度的截断值预测 SUI 的参数分别为 1mm、19cm、24mm 和 45°。对于所有参数组合，阴性预测值均超过 90%，但无一组合的敏感度超过 70%。当纳入三个或四个参数时，特异度约为 95%。组合的阳性预测值范围为 49.2%至 84.8%。 经阴道实时三维超声不足以预测 SUI，但可用于识别无 SUI 的女性。
