Prediction of Stress Urinary Incontinence Using the Retrovesical (β) Angle in Transperineal Ultrasound

Elham Keshavarz; Ensi Khalili Pouya; Maryam Rahimi; Tayebeh Jahed Bozorgan; Masoumeh Saleh; Zahra Mehdizadeh Tourzani; Kourosh Kabir; Mahmood Bakhtiyari

doi:10.1002/jum.15526

Prediction of Stress Urinary Incontinence Using the Retrovesical (β) Angle in Transperineal Ultrasound

J Ultrasound Med. 2021 Aug;40(8):1485-1493. doi: 10.1002/jum.15526. Epub 2020 Oct 9.

Authors

Elham Keshavarz¹, Ensi Khalili Pouya², Maryam Rahimi², Tayebeh Jahed Bozorgan³, Masoumeh Saleh³, Zahra Mehdizadeh Tourzani⁴, Kourosh Kabir⁵, Mahmood Bakhtiyari^{5

6}

Affiliations

¹ Clinical Research Development Center, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
² Department of Radiology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
³ Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
⁴ Department of Reproductive Health, Alborz University of Medical Sciences, Karaj, Iran.
⁵ Department of Community Medicine, Alborz University of Medical Sciences, Karaj, Iran.
⁶ Noncommunicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.

PMID: 33035377
DOI: 10.1002/jum.15526

Abstract

Objectives: The accurate, rapid diagnosis of stress urinary incontinence (SUI) in women can profoundly improve their sexual and psychosocial life. In this study, the diagnostic power of SUI was assessed by transperineal ultrasound.

Methods: In this hospital-based case-control study, married women who were referred to the gynecologic and ultrasound wards with negative urinalysis and culture results were enrolled by random sampling. Patients with positive cough signs based on the urodynamic testing data were considered cases, whereas control women showed no cough symptoms and were recruited from the same ward.

Results: There was a significant difference (P < .001) in bladder neck descent (mean ± SD, 10.89 ± 5.51 versus 7.08 ± 2.60 mm, respectively; P = .0001) and the retrovesical (β) angle with the Valsalva maneuver (144.22° ± 19.63° versus 111.81° ± 24.47°; P < .001) between the case and control groups. Also, the β angle without the Valsalva maneuver was higher in the case group (112.35° ± 23.10°) than the control group (120.17° ± 25.16°; P = .001). There was no case of a urinary leak, urethral diverticulitis, a bladder stone or mass, and cystourethrocele in the patients of each group. The results of multivariate logistic regression with a backward method showed that bladder neck descent (odds ratio [OR], 1.24; 95% confidence interval [CI], 1.09-1.40), the β angles with and without the Valsalva maneuver (OR, 1.1; 95% CI, 1.06-1.13; and OR, 1.04; 95% CI, 1.01-1.06) were the predictors of SUI. A β angle higher than 127° with the Valsalva maneuver, with an area under the curve of 0.89 (95% CI, 0.75-0.96), could very well predict the SUI response. This finding shows that it can be very well used to distinguish between normal and non-normal responses, with 89% sensitivity and 79% specificity.

Conclusions: The β angle with the Valsalva maneuver could very well predict the SUI response.

Keywords: diagnosis; female urogenital diseases; retrovesical angle; stress urinary incontinence; transperineal ultrasound.

MeSH terms

Case-Control Studies
Female
Humans
Male
Ultrasonography
Urethra / diagnostic imaging
Urinary Incontinence, Stress* / diagnostic imaging
Urodynamics