ABSTRACT
Objective:To assess the urethral mobility of normal parous women in China and explore the impacts of related risk factors on it using translabial ultrasound.Methods:Females who met the inclusion criteria in 37 tertiary hospitals from February 2017 to August 2018 were included. All women underwent standardized translabial ultrasound examination and the urethral rotation angle (URA), bladder neck position at maximum Valsalva maneuver (BNP-V) and bladder neck descent (BND) were measured. Questionnaires were used to collect basic information including age, height, weight, body mass index (BMI), past medical history, maternity history, and urinary incontinence related history. Mann-Whitney U test and multiple linear regression analysis were adopted to explore the influences of age, BMI, delivery mode and parity on normal parous women′s urethral mobility. Then, the study subjects were divided into different groups and the corresponding values of URA, BNP-V and BND were compared. Results:Compared with parous women with normal BMI and no history of vaginal delivery, those who were overweight and/or had a history of vaginal delivery were more likely to gain greater URA and BND ( P<0.05). The URA and BND were not significantly different between women with different times of cesarean sections ( P>0.05); while for women with a history of vaginal delivery, these two parameters increased with the increase of the number of transvaginal deliveries ( P<0.05). Conclusions:BMI and vaginal delivery are important risk factors for the urethral mobility of normal parous women. The urethral mobility increases with the increase of BMI and the number of vaginal deliveries.
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Objective:To investigate the feasibility of transperineal ultrasound in quantitative assessment of posterior compartment prolapse among Chinese women.Methods:The prospective multicenter study enrolled 485 women between January 2017 and January 2019. All patients underwent a standard clinical interview, pelvic organ prolapse quantification (POP-Q) examination and transperineal ultrasound examination. Volume data of transperineal ultrasound examinations were obtained at rest and in maximal Valsalva maneuver.Results:The higher POP-Q stage of posterior compartment, the lower rectal ampulla position in maximal Valsalva maneuver (POP-Q stage=0 vs POP-Q stage=1, P<0.001; POP-Q stage=1 vs POP-Q stage≥2, P<0.001), and the greater rectal ampulla hypermobility (POP-Q stage=0 vs POP-Q stage=1, P<0.001; POP-Q stage=1 vs POP-Q stage≥ 2, P=0.007). The rectal ampulla position at rest and in maximal Valsalva maneuver and rectocele depth were correlated with prolapse symptoms ( r=-0.200, P<0.001; r=-0.252, P<0.001; r=0.086, P=0.045). The corresponding cut-off values of rectal ampulla position in maximal Valsalva in diagnosing posterior compartment prolapse (POP-Q stage ≥1) and clinical significant posterior compartment prolapse (POP-Q stage ≥2) were 7.32 mm below the symphysis pubis and 12 mm below the symphysis pubis, respectively, with the area under the ROC curve as 0.75 and 0.85, respectively. Conclusions:The ultrasonic measurements by transperineal ultrasound is significantly associated with POP-Q examination in posterior compartment, and it is demonstrated as a useful tool in quantitative assessment of the severity of posterior compartment prolapse.
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Objective:To explore the value of 3D/4D translabial ultrasound in the diagnosis and differential diagnosis of female urethral diverticulum.Methods:The paired chi-square test was used to compare the diagnostic accuracy of 2D translabial ultrasound and 3D/4D translabial ultrasound in 21 suspected urethral diverticulum patients who visited the Third Affiliated Hospital of Sun Yat-Sen University from November 2013 to January 2020. And Kappa consistency test was used to evaluate the consistency between these two methods and the pathological results.Results:All 21 patients with suspected urethral diverticulum were diagnosed by postoperative pathology, of which 16 cases were urethral diverticula and 5 cases were paraurethral cysts. The typical appearance of urethral diverticulum on 3D/4D translabial ultrasound was a cystic structure traversing the urethral rhabdosphincter. Additionally, septa, calcification or solid neoplasm can also be seen in some cases. The sensitivity/specificity of 2D translabial ultrasound and 3D/4D translabial ultrasound were 75.00%/100% and 93.75%/100%, respectively, no statistical differences were found both in sensitivity and specificity between these two methods(all P>0.05). The Kappa consistency test showed that the consistency between 2D translabial ultrasound and pathological diagnosis was general (Kappa=0.588, P=0.003), while the consistency between 3D/4D translabial ultrasound and pathological diagnosis was good (Kappa=0.877, P<0.001). Conclusions:3D/4D translabial ultrasound has a high value in the diagnosis of female urethral diverticulum, and it is worthy of clinical application.