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.

Investigation of risk factors of de novo urinary stress incontinence after cystocele repair: A retrospective cohort study

“…The majority of prior studies regarding de novo USI have been focused on urethral obstruction or urodynamic studies, 3 with few concerned about the abnormal morphology of pelvic floor structures. In the present study, preoperative levator avulsion also seemed to be a risk factor for de novo USI after transvaginal mesh (TVM) surgery; however, no difference was found between the unilateral avulsion and bilateral avulsion group, which differs from previous studies 2 . The lack of difference between our two studied groups may be related to specific patient populations.…”

“…Prior studies have suggested that between 2% and 22% of pelvic organ prolapse patients, without concurrent baseline urinary stress incontinence (USI), can develop de novo USI after vaginal surgeries 1 . In our previous study, 2 unilateral levator avulsion was shown to be a risk factor for USI. Whether levator avulsion might be a risk factor for de novo USI has not yet been reported in the existing literature.…”

“…The lack of difference between our two studied groups may be related to specific patient populations. The previous study by Zhong et al 2 involved patients with USI, formed non‐surgically, and the present study involved patients with de novo USI after TVM surgery. The present study's results may help surgeons to construct individual therapy plans for patients without concurrent baseline USI before cystocele repair.…”

Der Staffelstab wird weitergereicht

“…It can also be used to specifically detect uterine abnormalities [16] or dislocations of intrauterine devices [17]. With translabial/ transperineal 3D sonography, the female pelvic floor and corresponding pelvic floor defects can be easily detected [18][19][20].…”

“…Auch können Uterusanomalien [16] oder Dislokationen von Intrauterin-Pessaren [17] damit gezielt nachgewiesen werden. Mit der translabialen/transperinealen 3D-Sonografie können der weibliche Beckenboden und auch entsprechende Beckenbodendefekte gut erkannt werden [18][19][20].…”