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Assessment of female pelvic floor support to the urethra using 3D transperineal ultrasound

  • Wen Shui
  • Yijia Luo
  • Tao YingEmail author
  • Qin LiEmail author
  • Chaoran Dou
  • Minzhi Zhou
Original Article
  • 28 Downloads

Abstract

Introduction and hypothesis

To explore the feasibility of three-dimensional (3D) transperineal tomographic ultrasound in evaluating pelvic floor support of the urethra in women.

Methods

Three-dimensional transperineal ultrasound volume data sets of 50 women with stress urinary incontinence (SUI) and 25 women without SUI were obtained for analysis. Pelvic floor support of the urethra was evaluated by studying the relationship between the urethra and vagina in vaginal cross section and quantified by estimating the urethral depression (UD) rate. The extent of paravaginal support at level II was also evaluated in tomographic ultrasound imaging (TUI) mode in all participants. Two-sample t-test and Mann-Whitney U test were used for statistical analysis.

Results

The extent of paravaginal support at level II showed no difference between the two groups. Posterior depression of the urethra into the anterior vaginal wall was increased in SUI (P < 0.05). When the UD rate value was 0.53 (CI 85%) combined with three continuous “abnormal slices,” the maximum Youden Index value (sensitivity 0.82, specificity 0.88) was obtained to screen dysfunctional support of the urethra.

Conclusions

The pelvic floor support of the urethra can be evaluated indirectly by studying the relationship between the urethra and anterior vaginal wall in the vaginal cross section by TUI. The obvious posterior depression of the urethra into the anterior vaginal wall could be indirect evidence of a defect in the support of the urethra.

Keywords

Ultrasound Pelvic floor Stress urinary incontinence Paravaginal support Urethral support 

Notes

Funding

This study was funded by the National Science Foundation of China (no. 81571699) and Shanghai Key Discipline of Medical Imaging (no. 2017ZZ02005).

Compliance with ethical standards

Conflicts of interest

None.

References

  1. 1.
    Komesu YM, Schrader RM, Ketai LH, Rogers RG, Dunivan GC. Epidemiology of mixed, stress, and urgency urinary incontinence in middle-aged/older women: the importance of incontinence history. Int Urogynecol J. 2016;27(5):763–72.  https://doi.org/10.1007/s00192-015-2888-1.CrossRefGoogle Scholar
  2. 2.
    Reynolds WS, Dmochowski RR, Penson DF. Epidemiology of stress urinary incontinence in women. Curr Urol Rep. 2011;12(5):370–6.  https://doi.org/10.1007/s11934-011-0206-0.CrossRefGoogle Scholar
  3. 3.
    Wu JM, Vaughan CP, Goode PS, Redden DT, Burgio KL, Richter HE, et al. Prevalence and trends of symptomatic pelvic floor disorders in US women. Obstet Gynecol. 2014;123(1):141–8.  https://doi.org/10.1097/AOG.0000000000000057.CrossRefGoogle Scholar
  4. 4.
    Nygaard I, Barber MD, Burgio KL, Kenton K, Meikle S, Schaffer J, et al. Prevalence of symptomatic pelvic floor disorders in US women. Jama. 2008;300(11):1311–6.  https://doi.org/10.1001/jama.300.11.1311.CrossRefGoogle Scholar
  5. 5.
    Stothers L, Friedman B. Risk factors for the development of stress urinary incontinence in women. Curr Urol Rep. 2011;12(5):363–9.  https://doi.org/10.1007/s11934-011-0215-z.CrossRefGoogle Scholar
  6. 6.
    Ashton-Miller JA, Howard D, DeLancey JO. The functional anatomy of the female pelvic floor and stress continence control system. Scand J Urol Nephrol Suppl. 2001;(207):1–7 discussion 106-125.Google Scholar
  7. 7.
    Delancey JO. Fascial and muscular abnormalities in women with urethral hypermobility and anterior vaginal wall prolapse. Am J Obstet Gynecol. 2002;187(1):93–8.CrossRefGoogle Scholar
  8. 8.
    DeLancey JO. Structural support of the urethra as it relates to stress urinary incontinence: the hammock hypothesis. Am J Obstet Gynecol. 1994;170(6):1713–20. discussion 1720-1713.CrossRefGoogle Scholar
  9. 9.
    Petros PE, Ulmsten UI. An integral theory of female urinary incontinence. Experimental and clinical considerations. Acta Obstet Gynecol Scand Suppl. 1990;153:7–31.CrossRefGoogle Scholar
  10. 10.
    Yang A, Mostwin JL, Rosenshein NB, Zerhouni EA. Pelvic floor descent in women: dynamic evaluation with fast MR imaging and cinematic display. Radiology. 1991;179(1):25–33.  https://doi.org/10.1148/radiology.179.1.2006286.CrossRefGoogle Scholar
  11. 11.
    Shek KL, Dietz HP. The urethral motion profile: a novel method to evaluate urethral support and mobility. Aust N Z J Obstet Gynaecol. 2008;48(3):337–42.  https://doi.org/10.1111/j.1479-828X.2008.00877.x.CrossRefGoogle Scholar
  12. 12.
    Dietz HP. Ultrasound imaging of the pelvic floor. Part I: two-dimensional aspects. Ultrasound Obstet Gynecol. 2004;23(1):80–92. https://doi.org/10.1002/uog.939.CrossRefGoogle Scholar
  13. 13.
    Huddleston HT, Dunnihoo DR, Huddleston PM 3rd, Meyers PC Sr. Magnetic resonance imaging of defects in DeLancey's vaginal support levels I, II, and III. Am J Obstet Gynecol. 1995;172(6):1778–82. discussion 1782-1774.CrossRefGoogle Scholar
  14. 14.
    Macura KJ, Thompson RE, Bluemke DA, Genadry R. Magnetic resonance imaging in assessment of stress urinary incontinence in women: parameters differentiating urethral hypermobility and intrinsic sphincter deficiency. World J Radiol. 2015;7(11):394–404.  https://doi.org/10.4329/wjr.v7.i11.394.CrossRefGoogle Scholar
  15. 15.
    Tillack AA, Joe BN, Yeh BM, Jun SL, Kornak J, Zhao S, et al. Vaginal shape at resting pelvic MRI: predictor of pelvic floor weakness? Clin Imaging. 2015;39(2):285–8.  https://doi.org/10.1016/j.clinimag.2014.10.007.CrossRefGoogle Scholar
  16. 16.
    Dietz HP, Pang S, Korda A, Benness C. Paravaginal defects: a comparison of clinical examination and 2D/3D ultrasound imaging. Aust N Z J Obstet Gynaecol. 2005;45(3):187–90.  https://doi.org/10.1111/j.1479-828X.2005.00377.x.CrossRefGoogle Scholar
  17. 17.
    Dietz HP, Steensma AB, Hastings R. Three-dimensional ultrasound imaging of the pelvic floor: the effect of parturition on paravaginal support structures.Ultrasound Obstet Gynecol. 2003;21(6):589–95.  https://doi.org/10.1002/uog.100.CrossRefGoogle Scholar
  18. 18.
    Tunn R, Goldammer K, Neymeyer J, Gauruder-Burmester A, Hamm B, Beyersdorff D. MRI morphology of the levator ani muscle, endopelvic fascia, and urethra in women with stress urinary incontinence. Eur J Obstet Gynecol Reprod Biol. 2006;126(2):239–45.  https://doi.org/10.1016/j.ejogrb.2005.10.018.CrossRefGoogle Scholar
  19. 19.
    Arenholt LTS, Pedersen BG, Glavind K, Glavind-Kristensen M, DeLancey JOL. Paravaginal defect: anatomy, clinical findings, and imaging. Int Urogynecol J. 2017;28(5):661–73.  https://doi.org/10.1007/s00192-016-3096-3.CrossRefGoogle Scholar
  20. 20.
    Schussler B, Alloussi S. [Ingelman-Sundberg classification of stress incontinence]. Gynakol Rundsch. 1983;23(3):166–74.CrossRefGoogle Scholar
  21. 21.
    Haylen BT, de Ridder D, Freeman RM, Swift SE, Berghmans B, Lee J, et al. An international urogynecological association (IUGA)/international continence society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol Urodyn. 2010;29(1):4–20.  https://doi.org/10.1002/nau.20798.Google Scholar
  22. 22.
    Dou C, Li Q, Ying T, Shui W, Yan Y, Luo Y, et al. Value of transperineal ultrasound on the observation of paravaginal support. Arch Gynecol Obstet. 2018;297(4):943–9.  https://doi.org/10.1007/s00404-018-4659-y.CrossRefGoogle Scholar
  23. 23.
    Delancey JO. Why do women have stress urinary incontinence? Neurourol Urodyn. 2010;29(Suppl 1):S13–7.  https://doi.org/10.1002/nau.20888.CrossRefGoogle Scholar
  24. 24.
    DeLancey JO. Anatomy and physiology of urinary continence. Clin Obstet Gynecol. 1990;33(2):298–307.CrossRefGoogle Scholar
  25. 25.
    Heilbrun ME, Nygaard IE, Lockhart ME, Richter HE, Brown MB, Kenton KS, et al. Correlation between levator ani muscle injuries on magnetic resonance imaging and fecal incontinence, pelvic organ prolapse, and urinary incontinence in primiparous women. Am J Obstet Gynecol. 2010;202(5):488 e481–6.  https://doi.org/10.1016/j.ajog.2010.01.002.CrossRefGoogle Scholar
  26. 26.
    Morgan DM, Cardoza P, Guire K, Fenner DE, DeLancey JO. Levator ani defect status and lower urinary tract symptoms in women with pelvic organ prolapse. Int Urogynecol J. 2010;21(1):47–52.  https://doi.org/10.1007/s00192-009-0970-2.CrossRefGoogle Scholar
  27. 27.
    Shek KL, Pirpiris A, Dietz HP. Does levator avulsion increase urethral mobility? Eur J Obstet Gynecol Reprod Biol. 2010;153(2):215–9.  https://doi.org/10.1016/j.ejogrb.2010.07.036.CrossRefGoogle Scholar
  28. 28.
    Hegde A, Aguilar VC, Davila GW. Levator ani defects in patients with stress urinary incontinence: three-dimensional endovaginal ultrasound assessment. Int Urogynecol J. 2017;28(1):85–93.  https://doi.org/10.1007/s00192-016-3068-7.CrossRefGoogle Scholar
  29. 29.
    Cassado-Garriga J, Wong V, Shek K, Dietz HP. Can we identify changes in fascial paravaginal supports after childbirth? Aust N Z J Obstet Gynaecol. 2015;55(1):70–5.  https://doi.org/10.1111/ajo.12261.CrossRefGoogle Scholar

Copyright information

© The International Urogynecological Association 2019

Authors and Affiliations

  1. 1.Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in MedicineShanghai Jiao Tong University Affiliated Sixth People’s HospitalShanghaiChina
  2. 2.Medical Imaging DepartmentShanghai Jiahui International HospitalShanghaiChina

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