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.

Zusammenfassung

Ziel Untersuchung des Zusammenhangs zwischen Levator-Avulsion und Harnbelastungsinkontinenz (“urinary stress incontinence”, USI) mittels 3D/4D-transperinealen Ultraschalls.

Material und Methoden 842 Patienten, die von 2016–2019 in unserer Klinik waren, wurden für unsere Studie rekrutiert. Es wurde ein transperinealer 3D/4D-Ultraschall durchgeführt. Nach dem Standardgespräch und der klinischen Abklärung wurden die allgemeinen Befunde und Daten zum Levator hiatorius gesammelt und gemessen, um sie zwischen den Gruppen zu vergleichen. Die Odds Ratios (OR) der USI-Symptome bzw. der Ultraschallmerkmale bei Levator-Avulsion wurden berechnet.

Ergebnisse Insgesamt wurden 593 Frauen untersucht: 204 litten an einer Levator-Avulsion (96 Fälle von linksseitiger Avulsion, 80 Fälle von rechtsseitiger Avulsion und 28 Fälle von bilateraler Avulsion) und 389 Frauen hatten keine Avulsion. Der Zustand nach Schwangerschaft und Dammschnitt unterschied sich in den Avulsionsgruppen signifikant von der Nicht-Avulsionsgruppe. Signifikante Unterschiede wurden bei den transversalen Durchmessern und den anteroposterioren Durchmessern zwischen den Gruppen mit Levator-Avulsion und der Nicht-Avulsionsgruppe gefunden, aber es gab keinen Unterschied innerhalb der Avulsionsgruppen, unabhängig davon, ob sich die Patientin in Ruhe befand oder das Valsalva-Manöver durchführte. Interessanterweise wurde ein signifikanter Unterschied bezüglich des Auftretens von USI-Symptomen zwischen der Gruppe mit unilateraler Avulsion und der ohne Avulsion gefunden. Die Odds Ratio (OR) der USI-Symptome betrug in der Gruppe mit unilateraler Avulsion 2,786 (95 %-KI 1,663–4,669), jedoch 0,939 (95 %-KI 0,276–3,199) für die Gruppen mit bilateraler Avulsion und Nicht-Avulsion.

Schlussfolgerung Eine unilaterale Levator-Avulsion kann ein Risikofaktor für Belastungsinkontinenz sein.

Key words

transperineal ultrasound - urinary stress incontinence - levator ani avulsion - Gynecology

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