Objective: To study the structure and function of pelvic floor using 4D perineal ultrasonography, and to provide quantitative parameters and objective basis for the diagnosis of early postpartum stress urinary incontinence (SUI). Methods: A total of 30 women with SUI symptoms 42 to 100 days after dilivery were collected from the Second Affiliated Hospital of Baotou Medical College as the case group (SUI group), and 30 women without SUI symptoms in the same period as the control group (non-SUI group). Bladder neck mobility (BNM), urethral rotation angle (URA) and posterior bladder angle (RVA) were measured under different conditions, and the strain rate of levator ani muscle was calculated for analysis and comparison. The cut-off value of ultrasonic diagnosis was obtained by drawing the receiver operating characteristic curve (ROC). Results: There was no significant difference in general data between the two groups (P<0.05). The area shrinkage strain rate (εA1) in both SUI and non-SUI groups was positively correlated with the perimeter shrinkage strain rate (εC1) (r=0.617, P<0.01;r=0.457, P<0.05). The εC1 of both groups was positively correlated with the strain rate of diameter shrinkage (εL1) (r=0.569, P<0.01;r=0.563, P<0.01). The average area tensile strain rate (εA2) of the two groups was positively correlated with perimeter tensile strain rate (εC2) (r=0.370, P<0.01;r=0.647, P<0.01) and tensile strain rate (εL2) (r=0.663, P<0.01;r=0.427, P<0.01). εC2 in the two groups was both positively correlated with εL2 (r=0.785, P<0.01;r=0.542, P<0.01). The ROC curve showed that εA1 had the best diagnostic cutoff, the largest area under the curve (0.993 6), and the highest sensitivity (97.4%). Conclusion: The strain rate of levator ani muscle contraction is valuable in the diagnosis of early postpartum SUI.
YIN Jing
,
JING Yan
,
LI Yifan
,
ZHENG Yanfen
. Study of pelvic floor muscle strain rate in postpartum patients with stress urinary incontinence by perineal 4D ultrasound[J]. Journal of Baotou Medical College, 2024
, 40(10)
: 32
-37
.
DOI: 10.16833/j.cnki.jbmc.2024.10.007
[1] Bo KR, Frawley HC, Haylen BT, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for the conservative and nonpharmacological management of female pelvic floor dysfunction[J]. Int Urogynecol J, 2017, 28(2): 191-213.
[2] MckinnieV, Swift SE, Wang W, et al. The effect of pregnancy and mode of delivery on the prevalence of urinary and fecal incontinence[J]. Am J Obstet Gynecol, 2005, 193(2): 512-518.
[3] Zhu L, Li L, Lang JH, et al. Prevalence and risk factors for peri- and postpartum urinary incontinence in primiparous women in China: a prospective longitudinal study[J]. Int Urogynecol J, 2012, 23(5): 563-572.
[4] van Veelen A, Schweitzer K, van der Vaart H. Ultrasound assessment of urethral support in women with stress urinary incontinence during and after first pregnancy[J]. Obstet Gynecol, 2014, 124(2 Pt 1): 249-256.
[5] Ashton-Miller JA, Delancey JOL. Functional anatomy of the female pelvic floor[J]. Ann N Y Acad Sci, 2007, 1101: 266-296.
[6] Liu W, Qian LX. Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data[J]. Int Urogynecol J, 2022, 33(12): 3491-3497.
[7] Dietz HP, Shek C, Clarke B. Biometry of the pubovisceral muscle and levator hiatus by three-dimensional pelvic floor ultrasound[J]. Ultrasound Obstet Gynecol, 2005, 25(6): 580-585.
[8] Colquitt JL, Pignatelli RH. Strain imaging: the emergence of speckle tracking echocardiography into clinical pediatric cardiology[J]. Congenit Heart Dis, 2016, 11(2): 199-207.
[9] Smiseth O A, Torp H, Opdahl A, et al. Myocardial strain imaging: how useful is it in clinical decision making[J]. Eur Heart J, 2016, 37(15): 1196-1207.
[10] Thyer I, Shek C, Dietz HP. New imaging method for assessing pelvic floor biomechanics[J]. Ultrasound Obstet Gynecol, 2008, 31(2): 201-205.
[11] Svabík K, Shek KL, Dietz HP. How much does the levator hiatus have to stretch during childbirth[J]. BJOG, 2009, 116(12): 1657-1662.
[12] Youssef A, Fiorentini M, Donna GD, et al. The correlation between transperineal ultrasound assessment of the levator ani muscle and postpartum urinary incontinence[J]. Neurourol Urodyn, 2021, 40(7): 1786-1795.
[13] Li XM, Zhang LM, Li Y, et al. Usefulness of transperineal shear wave elastography of levator ani muscle in women with stress urinary incontinence[J]. Abdom Radiol, 2022, 47(5): 1873-1880.
[14] Liu W, Qian LX. Establishment and validation of a risk prediction model for postpartum stress urinary incontinence based on pelvic floor ultrasound and clinical data[J]. Int Urogynecol J, 2022, 33(12): 3491-3497.
[15] Dietz HP. Levator function before and after childbirth[J]. Aust N Z J Obstet Gynaecol, 2004, 44(1): 19-23.
[16] Luo D, Chen L, Yu XJ, et al. Differences in urinary incontinence symptoms and pelvic floor structure changes during pregnancy between nulliparous and multiparous women[J]. PeerJ, 2017, 5: e3615.
[17] Delancey JO, Trowbridge ER, Miller JM, et al. Stress urinary incontinence: relative importance of urethral support and urethral closure pressure[J]. J Urol, 2008, 179(6): 2286-2290.
[18] Dietz HP, Clarke B, Herbison P. Bladder neck mobility and urethral closure pressure as predictors of genuine stress incontinence[J]. Int Urogynecol J Pelvic Floor Dysfunct, 2002, 13(5): 289-293.
[19] Pregazzi R, Sartore A, Bortoli P, et al. Perineal ultrasound evaluation of urethral angle and bladder neck mobility in women with stress urinary incontinence[J]. BJOG, 2002, 109(7): 821-827.
[20] 张新玲. 实用盆底超声诊断学[M]. 北京: 人民卫生出版社, 2019: 38.
[21] Yan HL, Li PF, Jin CP, et al. Pelvic floor function and morphological abnormalities in primiparas with postpartum symptomatic stress urinary incontinence based on the type of delivery: a 1:1 matched case-control study[J]. Int Urogynecol J, 2022, 33(2): 245-251.