Association Between Urinary Stress Incontinence and Levator Avulsion Detected by 3D Transperineal Ultrasound

Abstract Purpose To determine the association between levator avulsion and urinary stress incontinence (USI) by 3/4D transperineal ultrasound. Materials and Methods 842 patients who were admitted to our hospital from 2016 to 2019 were recruited for our study. 3D/4D transperineal ultrasound was performed. After standard interview and clinical evaluation, general conditions and levator hiatus data were collected and measured to compare with each group. The odds ratio (OR) of USI symptoms or ultrasound features with levator avulsion were calculated. Results A total of 593 women were studied: 204 suffered from levator avulsion (96 cases of left-side avulsion, 80 cases of right-side avulsion and 28 cases of bilateral avulsion) and 389 women had no avulsion. The gravidity and episiotomy conditions of the avulsion groups were significantly different from the no-avulsion group. Significant differences were found in the transverse diameters and anteroposterior diameters between the levator avulsion group and the no-avulsion group, but there was no difference among the avulsion groups, regardless of whether the patient was at rest or performing the Valsalva maneuver. Interestingly, a significant difference was found in the presence of USI symptoms between the uni-avulsion group and the no-avulsion group. The odds ratio (OR) of USI symptoms in the uni-avulsion group is 2.786 (95 %CI, 1.663–4.669), but 0.939 (95 %CI, 0.276–3.199) for the bilateral avulsion and no-avulsion groups. Conclusion Unilateral levator avulsion may be a risk factor for urinary stress incontinence.

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Faculty Opinions recommendation of Differences in the biometry of the levator hiatus at rest, during contraction, and during valsalva maneuver between women with and without provoked vestibulodynia assessed by transperineal ultrasound imaging.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.726100446.793524479 ◽

2016 ◽

Author(s):

Steven Witkin

Keyword(s):

Ultrasound Imaging ◽

Valsalva Maneuver ◽

Transperineal Ultrasound ◽

Provoked Vestibulodynia ◽

Levator Hiatus

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Evaluation of isolated urinary stress incontinence according to the type of levator ani muscle lesion using 3/4D transperineal ultrasound 36 months post-partum

International Urogynecology Journal ◽

10.1007/s00192-016-3208-0 ◽

2016 ◽

Vol 28 (7) ◽

pp. 1019-1026 ◽

Cited By ~ 8

Author(s):

José Antonio García Mejido ◽

Pamela Valdivieso Mejias ◽

Ana Fernández Palacín ◽

María José Bonomi Barby ◽

Paloma De la Fuente Vaquero ◽

...

Keyword(s):

Stress Incontinence ◽

Post Partum ◽

Levator Ani ◽

Urinary Stress Incontinence ◽

Transperineal Ultrasound ◽

Levator Ani Muscle

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Pubococcygeal Sling versus Refixation of the Pubocervical Fascia in Vesicovaginal Fistula Repair: A Retrospective Review

Obstetrics and Gynecology International ◽

10.1155/2018/6396387 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Rachel Pope ◽

Prakash Ganesh ◽

Jeffrey Wilkinson

Keyword(s):

Residual Stress ◽

Stress Incontinence ◽

Vesicovaginal Fistula ◽

Primary Outcome ◽

Obstetric Fistula ◽

Urinary Stress Incontinence ◽

Fistula Repair ◽

Surgical Interventions ◽

Significant Difference ◽

Continence Status

Urethral incontinence is an issue for approximately 10–15% of women with an obstetric fistula. Various surgical interventions to prevent this exist, including the pubococcygeal sling and refixation of the pubocervical fascia. Neither has been evaluated in comparison to one another. Therefore, this retrospective evaluation for superiority was performed. The primary outcome was urinary stress incontinence, and secondary outcomes were operative factors. There were 185 PC slings, but 12 were excluded because of urethral plications. There were 50 RPCF procedures, but 3 were excluded because of urethral plications. Finally, there were 32 cases with both PC sling and RPCF procedures. All groups demonstrated a higher than expected fistula repair rate with negative dye tests in 84% of the PC sling group, 89.9% in the RPCF group, and 93.8% in the RPCF and PC groups. There were no statistically significant differences found in continence status between the three groups. Of those who underwent PC slings, 49% were found to have residual stress incontinence. Of those who underwent RPCF, 47.8% had stress incontinence. Of those with both techniques, 43.8% had residual stress incontinence. Pad weight was not significantly different between the groups. As there is no statistically significant difference, we cannot recommend one procedure over the other as an anti-incontinence procedure. The use of both simultaneously is worth investigating.

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Differences in the Biometry of the Levator Hiatus at Rest, During Contraction, and During Valsalva Maneuver Between Women With and Without Provoked Vestibulodynia Assessed by Transperineal Ultrasound Imaging

Journal of Sexual Medicine ◽

10.1016/j.jsxm.2015.12.009 ◽

2016 ◽

Vol 13 (2) ◽

pp. 243-252 ◽

Cited By ~ 10

Author(s):

Stéphanie Thibault-Gagnon ◽

Linda McLean ◽

Corrie Goldfinger ◽

Caroline Pukall ◽

Susan Chamberlain

Keyword(s):

Ultrasound Imaging ◽

Valsalva Maneuver ◽

Transperineal Ultrasound ◽

Provoked Vestibulodynia ◽

Levator Hiatus

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Outcome Assessment of the Marshall Coughing Test during Cervix Reposition Maneuver in Women with Urinary Stress Incontinence with/without Genital Prolapse

ISRN Urology ◽

10.5402/2012/109858 ◽

2012 ◽

Vol 2012 ◽

pp. 1-8

Author(s):

Vesna Antovska

Keyword(s):

Outcome Assessment ◽

Stress Incontinence ◽

Valsalva Maneuver ◽

Genital Prolapse ◽

Pelvic Organ ◽

Urinary Stress Incontinence ◽

Vaginal Wall ◽

Stage I ◽

Stage Ii ◽

Great Chance

Objectives. Outcome assessment of the Marshall coughing test (MT) during cervix reposition maneuver (CRM) in women with urinary stress incontinence (USI) with/without genital prolapse (GP). Study Design. 268 patients, divided into USIg () with isolated USI and USIGPg () with USI and GP stage I/II, additionally divided into USIGP(A) () with USI and GP stage I and USIGP(B) () with USI and GP stage II, were evaluated with pelvic organ prolapse quantification (POPQ), MT, and CRM. Results. (a) 7.58% had (+) MT with CRM in USIg; (b) in up to 96.15% MT became negative during CRM in USIGP(A); (c) in 51.72% MT became positive only during CRM, as a sign for occult USI in USIGP(B); (d) point Aa (POPQ), which is bladder neck(BN) projection on the anterior vaginal wall, was situated higher in rest position (RP), but moved lower during the Valsalva maneuver (VM) in USIg versus USIGPg (). Conclusion. CRM could be useful arm in selection of (1) patients with isolated USI and great chance for postoperative failure; (2) patients with USI+GP stage I, who need GP repair during antistress surgery; (3) patients with USI + GP stage II, who need antistress procedure during vaginal hysterectomy.

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Evaluation of transperineal ultrasound in diagnosis and grading of female genuine urinary stress incontinence

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2020.11.00491 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Ahmed El lithy

Keyword(s):

Stress Incontinence ◽

Color Doppler ◽

Urinary Stress Incontinence ◽

Transperineal Ultrasound ◽

Bladder Neck Descent ◽

Voiding Diary ◽

Point Pressure ◽

Posterior Urethra ◽

Proximal Urethra ◽

Α Angle

Stress urinary incontinence (SUI) has an observed prevalence of between 4%and 35%. Purpose: To determine the role of transperineal ultrasound in diagnosing stress incontinence, its degree and the possible cause by: Measuring the BN descent, urethral hypermobility, funneling of BN or proximal urethra, urethral diameter, posterior urethra vesical angle, associated cystocele Using color Doppler to detect escape of urine through the urethra. Methods: 52 female patients diagnosed to have genuine stress incontinence using 3 day voiding diary, simple questionnaire and confirmed by standard urodynamics. Classification of stress incontinence into mild, moderate and severe using Valsalva leak point pressure during urodynamic study. Transperineal ultrasound for evaluation of the anterior pelvic compartment regarding: bladder neck descent, urethralhy permobility, Funneling of the BN, posterior urethrovesical angle ,urethral diameter, associatedcystocele, and finally the Doppler detection of urinary escape both at rest and with Valsalva maneuvers. Results: 28/52 cases (53.8%) of SUI didn’t show clinical evidence of cystocele; 11 cases (21.2%) showed grade 1 cystocele and 13cases (25%) showed grade 2 cystocele. The presence or absence of cystocele and also the grade of cystocele did not show a statistically significant relation to the degree of SUI; p=0.089 and 0.086 respectively Conclusion: We came to conclusion that transperineal ultrasound can be used in accurate diagnosis and grading of female urinary stress incontinence with our given cutoff values for bladder displacement, α angle, β angle and urethral diameters and from this grading by transperineal ultrasound comes the novelity of our research.

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Transperineal Ultrasound Assessment of a Cystocele’s Impact on the Bladder Neck Mobility in Women with Stress Urinary Incontinence

Medicina ◽

10.3390/medicina55090562 ◽

2019 ◽

Vol 55 (9) ◽

pp. 562

Author(s):

Maria-Patricia Rada ◽

Răzvan Ciortea ◽

Andrei Măluțan ◽

Doru Diculescu ◽

Costin Berceanu ◽

...

Keyword(s):

Urinary Incontinence ◽

Birth Weight ◽

Stress Urinary Incontinence ◽

Bladder Neck ◽

Valsalva Maneuver ◽

Transperineal Ultrasound ◽

Inferior Margin ◽

Significant Difference ◽

Neck Mobility ◽

Bladder Neck Mobility

Background and objectives: As pelvic floor disorders are often difficult to assess thoroughly based on clinical examination alone, the use of imaging as a complementary technique is helpful. This study’s aim was to investigate by transperineal ultrasound (US) if there was any significant difference in the mobility of the bladder neck in women with stress urinary incontinence (SUI) without a cystocele and in those with SUI and an associated cystocele. The study also investigated whether the number of vaginal births and/or the heaviest newborn’s birth weight was correlated with the bladder neck mobility. Materials and Methods: A total of 71 women suffering from SUI were included in the study and divided into two groups based on the presence of a cystocele. Their bladder neck mobility was evaluated by transperineal US, calculating the distance from the inferior margin of the symphysis pubis to the bladder neck (SPBN), and the dorsocaudal linear movement (DLM), term used to illustrate the displacement of the bladder neck by subtracting rest and Valsalva values. GraphPad Prism 8 was used for statistical analysis. Results: Within both study groups, the SPBN values were significantly higher and the DLM values were significantly lower at rest as compared to Valsalva maneuver (p < 0.05). No significant difference between the groups regarding SPBN and DLM values at rest, Valsalva, or subtraction was demonstrated. A significant positive correlation was found between the bladder neck mobility and the heaviest newborn’s birth weight, regardless of the presence of a cystocele (p = 0.042). Conclusions: The presence of a cystocele had no significant impact on the bladder neck mobility measurements in patients with SUI. The heaviest newborn’s birth weight positively correlated with bladder neck hypermobility, as quantified by SPBN.

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