Analysis of smart pelvic floor ultrasound in evaluating levator ani morphology and the diagnostic efficacy for new-onset urinary incontinence in postoperative pelvic organ prolapse patients
Objective To explore the evaluation of levator ani morphology using smart pelvic floor ultrasound in postoperative pelvic organ prolapse(POP)patients and its diagnostic efficacy for new-onset urinary incontinence.Methods 90 postoperative POP patients treated at Cangzhou People's Hospital from February 2019 to May 2022 were selected as the case group,and 100 healthy postpartum women who underwent physical examination at the same hospital were selected as the control group.Based on the occurrence of new-onset urinary incontinence,the patients after POP were divided into the occurrence group(n=46)and the non-occurrence group(n=44).Smart pelvic floor ultrasound was used to compare the quantitative parameters between the groups with and without new-onset urinary incontinence.Smart pelvic floor ultrasound was used to evaluate the morphological characteristics of levator ani muscle in postoperative POP patients with and without new-onset urinary incontinence.Multivariate Logistic regression analysis was used to identify risk factors influencing the occurrence of new-onset urinary incontinence,and a nomogram model was established and validated.The receiver operating characteristic(ROC)curve was used to evaluate the diagnostic efficacy of various factors for new-onset urinary incontinence.Results The urethral rotation angle(URA),bladder neck descent(BND),and resting and Valsalva retrovesical angles(RVA)in the case group were significantly higher than those in the control group,while the distance from the bladder neck to the lower edge of the pubic symphysis(BSD)and the distance from the lowest point of the rectal ampulla to the lower edge of the pubic symphysis(RAD)were significantly lower(t values between 3.562 and 17.413,P＜0.05).New-onset urinary incontinence patients had higher URA,BND,and RVA values at rest and during Valsalva compared to those without new-onset urinary incontinence,while BSD and RAD values were lower(t values between 3.326 and 7.320,P＜0.05).The levator hiatus width(LHW),H-line,and M-line values at rest and during maximum effort were greater in POP postoperative patients with new-onset urinary incontinence,and bilateral asymmetry scores were lower(t values between 4.128 and 24.857,P＜0.05).Multivariate Logistic regression analysis indicated that menopause,preoperative UDS-urethral obstruction,and reduced levels of maximum urine flow rate,average urine flow rate,and maximum urethral closure pressure(MUCP)were risk factors for new-onset urinary incontinence,with OR values and 95％CI of 1.225(1.064-1.720),1.580(1.194-1.865),0.458(0.212-0.844),0.406(0.201-0.742),and 0.520(0.144-0.805),respectively.ROC curve analysis showed that combined prediction of RVA,urethral tilt angle(UTA),BSD,RAD,URA,and BND had the best diagnostic efficacy for new-onset urinary incontinence,with an area under the curve of 0.889.The model evaluation indicated that the constructed nomogram prediction model had high discrimination(92.35％),accuracy(90.26％),and clinical applicability.Conclusion Compared to healthy postoperative women,postoperative POP patients exhibit significant changes in quantitative parameters of smart pelvic floor ultrasound.Postoperative POP patients with new-onset urinary incontinence show significant changes in levator ani morphology,which can be accurately assessed using intelligent pelvic floor ultrasound.
pelvic floor ultrasoundpelvic organ prolapselevator ani morphologyurinary incontinencediagnostic efficacy
万方数据
维普
