Possibilities of elastography in the diagnosis of stress urinary incontinence in women

Abstract

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.