International Urogynecology Journal

, Volume 26, Issue 10, pp 1495–1502 | Cite as

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

  • Cosimo Cosimato
  • Lucio M. A. Cipullo
  • Jacopo Troisi
  • Attilio Di Spiezio Sardo
  • Giovanni Antonio TommaselliEmail author
  • Rosa Rita Oro
  • Fulvio Zullo
  • Vincenzo Altieri
  • Maurizio Guida
Original Article


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.


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.


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.


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.


Pubovesical angle Retrovesical angle Stress urinary incontinence Ultrasound parameters Pregnancy 


Conflicts of interest

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


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Copyright information

© The International Urogynecological Association 2015

Authors and Affiliations

  • Cosimo Cosimato
    • 1
  • Lucio M. A. Cipullo
    • 1
  • Jacopo Troisi
    • 1
  • Attilio Di Spiezio Sardo
    • 2
  • Giovanni Antonio Tommaselli
    • 2
    • 5
    Email author
  • Rosa Rita Oro
    • 3
  • Fulvio Zullo
    • 1
  • Vincenzo Altieri
    • 4
  • Maurizio Guida
    • 1
  1. 1.Department of Gynecology and Obstetrics of San Giovanni di Dio and Ruggi d’Aragona HospitalUniversity of SalernoSalernoItaly
  2. 2.Department of Obstetrics, Gynecology and UrologyUniversity of Naples ‘Federico II’NaplesItaly
  3. 3.Academic School of Midwifery, San Giovanni di Dio and Ruggi d’Aragona HospitalUniversity of SalernoSalernoItaly
  4. 4.Department of Urology of San Giovanni di Dio and Ruggi d’Aragona HospitalUniversity of SalernoSalernoItaly
  5. 5.Department of Obstetrics, Gynecology and UrologyUniversity of Naples “Federico II”NaplesItaly

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