Study on the Diagnostic Value of Transperineal Pelvic Floor Ultrasound Parameters in Pelvic Organ Prolapse with Stress Urinary Incontinence

Abstract

Objective: The purpose of this study is to determine the diagnostic vaule of transperineal pelvic floor ultrasound(TPFU) for predicting pelvic organ prolapse (POP) and stress urinary incontinence (SUI). Subjects and methods: From January 2021 to May 2025, women
diagnosed POP with or without SUI were prospectively recruited. All subjects underwent transperineal pelvic floor ultrasound at Shanghai
Fourth Peoples Hospital. Based on the presence or absence of SUI, the patients were categorized into two groups, the POP with SUI group
and the POP group. All the ultrasound data were obtained by the same ultrasound physician who was unaware of the diagnosis, which included the cervical position at rest (CP-R), bladder neck position at rest (BNP-R), posterior vesicourethral angle at rest (PVA-R), cervical position on maximal Valsalva maneuver (CP-V ), bladder neck position on maximal Valsalva maneuver (BNP-V), posterior vesicourethral angle
on maximal Valsalva maneuver (PVA-V), lowest point of the bladder on maximal Valsalva maneuver (LPB-V). bladder neck descent (BND),
urethral rotation angle (URA)and levator hiatus area(LHA). We used SPSS 27.0 software to identified the parameters that showed statistically
significant differences between the two groups. ROC curves were constructed to determine the optimal cutoff values of the parameters with
statistically significant differences and all combinations of parameters to predict SUI in the POP patients. Result: Included were 102 women
with POP (aged 65.086.70 years) and 54 with POP and SUI (aged 63.876.46 years). In our analysis, we observed notable differences in
TPFU parameters between the POP with SUI group and the POP group. Specifically, the CP-R, CP-V, PVA-R, PVA-V, and BND were significantly higher in the POP with SUI group compared to the POP group. Conversely, LHA was smaller in the POP with SUI group. These
findings were statistically significant(P<0.05.)However, no significant differences were observed between the two groups in terms of LPB-V,
BNP-R, BNP-V, or URA(P>0.05). The ROC curve analysis revealed that various pelvic floor ultrasound parameters had different diagnostic
accuracies for predicting POP with SUI. Specifically, the AUC values for CP-R, CP-V, PVA-R, PVA-V, BND and LHA were 0.683, 0.746,
0.650, 0.713, 0.597 and 0.657, respectively. Notably, the CP-V had the highest AUC of 0.746 [95%CI (0.667, 0.826)]. When these indicators
were combined, the AUC increased to 0.818 [95%CI(0.748, 0.887)], which was statistically significantly higher than when they were used
individually (P < 0.05). Conclusion: Various factors such as cervical position, PVA, BND, and LHA can be predictive of POP with SUI in the
POP patients. When these parameters are combined, they showed a moderate diagnostic value with an AUC of 0.818. This suggests that these
combined factors can be useful in assessing and diagnosing POP and SUI.