Dynamic observation and evaluation of pelvic floor in female with stress urinary incontinence by perineal two-dimensional ultrasound

Objective To observe and evaluate the dynamic changes of pelvic floor in female with stress urinary incontinence(SUI) by perineal two-dimensinal ultrasound.Methods Perineal two-dimensinal ultrasound were performed in 32 female with SUI(SUI group) and 35 postpartum women without SUI(control group) in the condition of resting,Valsalva maneuver and anal sphincter contraction.The position,shape and movement of pelvic organs were observed and two-dimensional diameters of pelvic structures were measured and analyzed.Results By two-dimensional ultrasound,the bladder neck and urethra in both groups were observed moving backward and down on movement Valsalva,while they both moved forward and above during anal sphincter contracting.The urethra of 71.4%(25/35) cases in control group were liner type on Valsalva movement,28.6%(10/35) went backward,8.6%(3/35) became funnel form.On Valsalva movement,87.5%(28/32) of urethra in SUI group went back obviously,28.1%(9/32)became funnel form.When resting state,the horizon distance(x) between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group(t=-5.467,P=0.000).The vertical distance(y) between the bladder neck and symphysis pubis,the distance between the knee portion of urethra and X-axis,and the angle of the urethra in SUI group were significantly less than those in control group(t=7.075,5.760,4.038,all P=0.000).The length of whole urethra and the functional segment of proximal urethra in SUI group were both less than those in control group,but they were no significant difference(t=1.724,1.702,all P0.05).On Valsalva movement,the horizon distance(x) between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group(t=-4.618,P=0.000).The vertical distance(y) between the bladder neck and symphysis pubis,the length of proximal urethra and the angle of the urethra in SUI group were all significantly less than those of control group(t=1.259,8.657,4.574,all P=0.000).The distance between the knee portion of urethra and X-axis were(0.36±0.34)cm(above the inferior part of symphysis pubis) and-(0.28±0.27)cm(blow the inferior part of symphysis pubis),and there was significant difference between them(t=-8.568,P=0.000).The length of urethra in SUI group was less than that in control group,but there was no significant difference between them(t=1.974,P=0.053).When anal sphincter contracting,the horizon distance(x) between the bladder neck and symphysis pubis in SUI group was significantly greater than that in control group(t=-7.001,P=0.000).The vertical distance(y) between the bladder neck and symphysis pubis,the length of proximal urethra and the angle of urethra in SUI group were all significantly less than those in control group(t=6.361,2.444,2.285,all P 0.01 or 0.05).The distance between the knee of urethra and X-axis in SUI group were(0.04±0.03)cm(above the inferior of symphysis pubis) and-(0.33±0.25)cm(blow the inferior of symphysis pubis),and there was significant difference between them(t=-8.312,P=0.000).The length of urethra in SUI group was less than that in control group,but there was no significant difference(t=1.972,P=0.053).Conclusions Perineal two-dimensional ultrasound is helpful to assess the dynamic changes of pelvic structures in female with and without SUI at states of resting,Valsalva movement and anal contracting.It indicates that SUI may be due to the defect of supporting structures for bladder neck and urethral.