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Ultrasonographic evaluation of urethrovesical junction mobility: correlation with type of delivery and stress urinary incontinence

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Abstract

Introduction and hypothesis

A relationship between urinary incontinence and hypermobility of the urethrovesical junction (UVJ) during pregnancy has been described. The aim of the study was to compare the effects of vaginal delivery (VD) and caesarean section (CS) on UVJ mobility.

Methods

The retrovesical angle (RVA) and the anterior angle between the UVJ and the pubic bone, the pubovesical angle (PVA), were evaluated ultrasonographically in controls and pregnant women during their first pregnancy between 38 and 40 weeks, and then re-evaluated 6 weeks and 6 months after delivery. All patients completed a validated questionnaire (ICIQ-SF). Differences between and within groups were assessed with Student’s t test, the chi-squared test for trend, and one-way two-tailed analysis of variance with Scheffé’s post-hoc test. The correlation between PVA and RVA was evaluated using the Spearman R correlation. The positive predictive value, negative predictive value, sensitivity and specificity for the prediction of stress urinary incontinence (SUI) symptoms were also determined.

Results

Included in the study were 42 controls and 217 pregnant women. PVA at rest, during cough and Valsalva manoeuvre was significantly higher in pregnant women than in controls and in women 6 weeks after VD in comparison with women who had undergone CS. Patients affected by SUI showed a significantly higher PVA. RVA did not differ between subjects affected or not by SUI symptoms. PVA and RVA were not correlated with each other.

Conclusions

PVA and RVA are increased in pregnant women in comparison with controls. In patients undergoing VD, PVA is restored significantly later than in those undergoing CS. The change in RVA after pregnancy and delivery seems to persist longer than the change in PVA.

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Conflicts of interest

Giovanni A. Tommaselli is consultant for Solace Therapeutics and Ethicon.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics of San Giovanni di Dio and Ruggi d’Aragona Hospital, University of Salerno, Salerno, SA, Italy

    Cosimo Cosimato, Lucio M. A. Cipullo, Jacopo Troisi, Fulvio Zullo & Maurizio Guida

  2. Department of Obstetrics, Gynecology and Urology, University of Naples ‘Federico II’, Naples, Italy

    Attilio Di Spiezio Sardo & Giovanni Antonio Tommaselli

  3. Academic School of Midwifery, San Giovanni di Dio and Ruggi d’Aragona Hospital, University of Salerno, Salerno, SA, Italy

    Rosa Rita Oro

  4. Department of Urology of San Giovanni di Dio and Ruggi d’Aragona Hospital, University of Salerno, Salerno, SA, Italy

    Vincenzo Altieri

  5. Department of Obstetrics, Gynecology and Urology, University of Naples “Federico II”, Via S. Pansini, 5, 80131, Naples, Italy

    Giovanni Antonio Tommaselli

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  1. Cosimo Cosimato
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  2. Lucio M. A. Cipullo
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Correspondence to Giovanni Antonio Tommaselli.

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Cosimato, C., Cipullo, L.M.A., Troisi, J. et al. Ultrasonographic evaluation of urethrovesical junction mobility: correlation with type of delivery and stress urinary incontinence. Int Urogynecol J 26, 1495–1502 (2015). https://doi.org/10.1007/s00192-015-2736-3

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  • DOI: https://doi.org/10.1007/s00192-015-2736-3

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