Use of Shear Wave Elastography to Evaluate Stress Urinary Incontinence in Women
Abstract: Objective: To compare the shear wave elastography (SWE) values of perineal tissues in female patients with stress urinary incontinence and those without incontinence.
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Possibilities of elastography in the diagnosis of stress urinary incontinence in women
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.
Possibilities of elastography in the diagnosis of stress urinary incontinence in women
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.
Minimally invasive correction of stress urinary incontinence in women with pelvic floor dysfunction
BACKGROUND: Pelvic floor dysfunction is widespread among young women. Stress urinary incontinence is a common manifestation of the dysfunction and, even in mild forms, affects the quality of life of patients. Much attention is focused on finding and improving minimally invasive methods for treating stress urinary incontinence in women of reproductive and perimenopausal age to prevent disease progression and improve quality of life. AIM: The aim of this study was to evaluate the immediate and long-term results of paraurethral injections of a high-density hyaluronic biopolymer for the correction of stress urinary incontinence in women of reproductive and perimenopausal age. MATERIALS AND METHODS: We examined 37 patients aged 44.6 ± 4.7 years with mild to moderate stress urinary incontinence combined with grade I to II genital prolapse. After general clinical and special studies (urination diaries, King’s and Pelvic Organ Prolapse / Urinary Incontinence Sexual Questionnaire, cough test, complex urodynamic study, ultrasound examination of the urethrovesical junction and pelvic floor ultrasound with compression elastography), paraurethral injection of 4.0 ml of the high-density hyaluronic biopolymer crosslinked with 1,4-butanediol diglycidyl ether was performed. The effectiveness of therapy was evaluated 1, 6 and 12 months after the procedure. RESULTS: A negative cough test was detected after one, six and 12 months of follow-up in 96.9, 73.1 and 43.8 % of women, respectively; the absence of stress urinary incontinence episodes according to urination diaries was in 85.7, 61.3 and 35.0 % of patients, respectively. Gradual resorption of the drug was monitored over 12 months of observation. An ultrasound examination showed a decrease in urethral mobility one month after the procedure. According to the results of elastography before treatment, the average value of the strain ratio of paraurethral tissues was 0.50 (0.30–0.69) (p 0.001), after one and six months — 0.88 (0.76–1.03) and 0.79 (0.66–1.07) (p 0.001 and p = 0.005 respectively). Thus, the stiffness of the paraurethral tissues of the proximal posterior wall of the urethra increased within six months after the procedure. When observing women after 12 months, the stiffness values of the studied tissues decreased and approached the values before treatment. During the entire observation period, the patients noted a decrease in the degree of discomfort due to problems with urination according to the questionnaires. CONCLUSIONS: The introduction of the high-density hyaluronic biopolymer helps to increase the stiffness of paraurethral tissues and improve the structural support of the urethra in patients with stress urinary incontinence. After the procedure, a 12-month follow-up revealed a decrease or absence of stress urinary incontinence episodes according to urination diaries and the preservation of the positive effect of treatment according to the results of the cough test. A gradual decrease in the effect of therapy is associated with biodegradation of the drug. This method of treating mild forms of stress urinary incontinence is effective for women of reproductive and perimenopausal age who do not plan surgical treatment, are interested in achieving a quick result of therapy and are informed that the effect decreases over time after the procedure.
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