4D Transperineal Ultrasound for the Diagnosis and Classification of Stress Urinary Incontinence in Postmenopausal Women.

OBJECTIVE

To explore 4D transperineal ultrasound (TPUS) parameters distinguishing urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in stress urinary incontinence (SUI).

STUDY DESIGN

Observational study. Place and Duration of the Study: The Second Affiliated Hospital of Soochow University, China, from January 2018 to January 2022.

METHODOLOGY

According to valsalva leak point pressure (VLPP), postmenopausal SUI women were divided into UH and ISD groups, and healthy women were set as control group. Medical data and ultrasound parameters were analysed for their diagnostic values on SUI.

RESULTS

In women with SUI, body mass index, parity, urethral funnel formation rate, bladder neck descent (BND), retrovesical angle (RVA) under the maximum valsalva manoeuver (MVM), urethral rotation angle (URA) and levator hiatus area (LHA) were higher, but bladder neck internal angle (BIA), urethral length (UL) at rest and UL under MVM were smaller than those in control (p<0.05). In the UH group, BIA, BND, and UL under MVM were higher, but ICIQ-SF score and urethral funnel formation rate were smaller than those in the ISD group, and Cystocele Green's type differed significantly (p<0.05). Smaller BIA, shorter UL under MVM, and higher ICIQ-SF score were more likely to diagnose ISD, while Cystocele Green's type II were likely to diagnose UH (p<0.05). The area under receiver operator characteristic curve of the logistic regression model was 0.864 with 90.6% sensitivity and 71.9% specificity. VLPP was positively correlated with BIA and UL under MVM but negatively correlated with the ICIQ-SF score.

CONCLUSION

Parameters of 4D TPUS can differentiate UH and ISD in SUI.

KEY WORDS

Stress urinary incontinence, Transperineal ultrasound, Valsalva leak point pressure, Urethral hypermobility, Intrinsic sphincter deficiency.