Cattani Laura, Van Schoubroeck Dominique, Samešova Adela, Packet Bram, Housmans Susanne, Deprest Jan
Department of Development and Regeneration, Cluster Urogenital Surgery, Biomedical Sciences, KU Leuven, Herestraat 49, 3000, Louvain, Belgium.
Department of Gynaecology and Obstetrics, UZ Leuven, Louvain, Belgium.
Int Urogynecol J. 2024 Dec;35(12):2423-2430. doi: 10.1007/s00192-024-05931-z. Epub 2024 Oct 1.
Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS.
This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront.
At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction.
In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.
妊娠和分娩易导致盆底功能障碍（PFD），同时伴有盆底的功能和解剖结构变化。在一定程度上，这些变化可通过经会阴超声（TPUS）进行评估，但超声检查结果与症状之间的相关性尚未得到充分阐明。我们假设患有PFD的孕妇在TPUS检查中会有不同的表现。
这是一项对前瞻性队列研究的计划二次分析。要求孕妇填写关于PFD的标准化问卷，并在妊娠12 - 14周和28 - 32周时接受TPUS检查。我们使用t检验和Fisher精确检验比较了有PFD和无PFD的女性之间膀胱颈下移、尿道旋转、膀胱后角、盆腔器官下移、生殖裂孔尺寸以及肛门括约肌缺陷的情况。使用线性混合效应模型评估TPUS检查结果与PFD严重程度之间的相关性。由于这是对接受TPUS检查的参与者进行的二次亚组分析，未预先确定样本量。
在做瓦尔萨尔瓦动作时，尿失禁女性的膀胱颈下移（p = 0.02）和尿道旋转（p < 0.01）更明显，膀胱后角更宽（p = 0.04），生殖裂孔面积更大（p < 0.01）。在控制年龄、体重指数和产次后，膀胱后角是尿失禁的唯一持续预测指标。未观察到任何TPUS标志物与脱垂或肛门直肠功能障碍症状之间存在相关性。
在孕妇中，尿失禁症状而非脱垂和肛门直肠功能障碍症状与TPUS检查时盆底解剖结构的差异有关。
