Possibilities of elastography in the diagnosis of stress urinary incontinence in women

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BACKGROUND: Stress urinary incontinence in women is a widespread disease. It can occur in women of reproductive age, while progressing and disrupting the quality of life. Ultrasound elastography allows for evaluating the stiffness of the urethral supporting structures and can help in studying the pathophysiology of stress urinary incontinence and in diagnosing its mild forms for timely initiation of therapy and preventing the development of severe forms of the disease.

AIM: The aim of this study was to improve the diagnosis of mild stress urinary incontinence in women using ultrasound compression elastography of the ureterovesical junction.

MATERIALS AND METHODS: We examined 25 women with mild stress urinary incontinence (main group) and 15 patients without urinary incontinence (control group) of reproductive and perimenopausal age. The diagnosis of stress urinary incontinence was confirmed during a comprehensive urodynamic study. To assess the urethral mobility and determine the stiffness of the supporting structures, a 2D ultrasound examination was performed with compression elastography of the ureterovesical junction using Voluson E6 and E10 ultrasound systems equipped with a transvaginal probe (GE Healthcare, USA). Four areas of interest in the paraurethral region of the proximal and middle urethra were examined. The obtained elastograms were used to evaluate the color characteristics and strain ratio of the areas of interest in three dimensions, the average values being calculated.

RESULTS: The strain ratios in all studied areas of the paraurethral region had no significant relationship with age and were lower in patients with stress urinary incontinence compared to control values (p < 0.01). Urethral hypermobility (mobility: mean urethral α angle rotation of 40 degrees) was identified in 84% of women with stress urinary incontinence. According to the results of correlation analysis, the strain ratios in the three areas of interest had a significant negative relationship with changes in the urethral α angle rotation. The ROC analysis showed that the stiffness values of the paraurethral region of the proximal posterior wall of the urethra are the most significant parameters for the diagnosis of stress urinary incontinence. The threshold value of the strain ratio for diagnosing stress urinary incontinence was determined to be less than or equal to 0.85 (sensitivity 96.0%; specificity 86.7%; p < 0.001).

CONCLUSIONS: Ultrasound compression elastography of the ureterovesical junction is a new non-invasive technique that can improve the accuracy of diagnosing stress urinary incontinence in women. It is advisable to use the technique in women with mild stress urinary incontinence who are planned for conservative treatment to confirm the diagnosis and monitor therapy.

作者简介

Elena Rusina

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: pismo_rusina@mail.ru
ORCID iD: 0000-0002-8744-678X

MD, Dr. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Maria Zhevlakova

Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: gynecologist.spb@mail.ru
ORCID iD: 0009-0005-2084-3894
SPIN 代码: 5889-2765

MD

俄罗斯联邦, Saint Petersburg

Elizaveta Shelayeva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

Email: eshelaeva@yandex.ru
ORCID iD: 0000-0002-9608-467X
SPIN 代码: 7440-0555

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Stanislava Nagorneva

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O.Ott

Email: stanislava_n@bk.ru
ORCID iD: 0000-0003-0402-5304
SPIN 代码: 5109-7613

MD, Cand. Sci. (Med.)

俄罗斯联邦, Saint Petersburg

Maria Yarmolinskaya

The Research Institute of Obstetrics, Gynecology and Reproductology named after D.O. Ott

编辑信件的主要联系方式.
Email: m.yarmolinskaya@gmail.com
ORCID iD: 0000-0002-6551-4147
SPIN 代码: 3686-3605

MD, Dr. Sci. (Med.), Professor, Professor of the Russian Academy of Sciences

俄罗斯联邦, Saint Petersburg

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2. Fig. 1. Shape and topographic relations of the urethral supporting structures [23]. Urethral supporting structures in the posterosuperior view: urethral sphincter complex (a), including compressor urethra, urethrovaginal sphincter and urethral sphincter proper. Supporting structures of the urethra, including: pubovesical muscle (b), pubovesical ligament (c), lateral vesical ligament (d), tendinous arch of pelvic fascia (e), and urethrovaginal septum (f). Ante, anterior; AVW, anterior vaginal wall; CU, compressor urethra; LVL, lateral vesical ligament; PB, pubic bone; Post, posterior; PVL, pubovesical ligament; PVM, pubovesical muscle; TAPF, tendinous arch of pelvic fascia; USP, urethral sphincter proper; UVS, urethrovaginal sphincter [23]

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3. Fig. 2. Investigation of the ureterovesical junction of a patient using transperineal access, with the studied urethral supporting structures indicated (Voluson E10 ultrasound system; RIC 5-9-D transvaginal probe): a, 2D echogram; b, elastography. 1, pubic bone; 2, adipose tissue of the retropubic space (control area); 3, posterior vaginal wall with pubocervical fascia near the posterior wall of the proximal urethra (first area of interest); 4, posterior vaginal wall with pubocervical fascia next to the back wall of the middle part of the urethra (second area of interest); 5, compressor urethra and urethrovaginal sphincter, forming rhabdosphincter (third area of interest); 6, pubovesical muscle (fourth area of interest)

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4. Fig. 3. Scheme of location of the control area and areas of interest for elastographic evaluation of supporting structures of the ureterovesical junction in patients with stress urinary incontinence. Сontrol area, which corresponds to the location of adipose tissue of the retropubic space. 1, paraurethral region of the posterior wall of the proximal urethra (first area of interest); 2, paraurethral region of the posterior wall of the middle urethra (second area of interest); 3, paraurethral region of the anterior wall of the middle urethra (third area interest); 4, paraurethral region of the anterior wall of the proximal urethra (fourth area of interest)

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5. Fig. 4. Probability of stress urinary incontinence depending on the strain ratio of the first area of interest

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6. Fig. 5. Compression elastography of the ureterovesical junction of a patient with stress urinary incontinence using transperineal access (Voluson E10 ultrasound system; RIC 5-9-D transvaginal probe)

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