Application of transperineal ultrasonography in diagnosis of female anterior pelvic cavity dysfunction

Abstract

Objective To explore the value of transperineal ultrasonography in diagnosis of female anterior pelvic cavity dysfunction. Methods From April to November 2014, a total of 68 cases of outpatients with frequent urination, urgency, dysuria and rotor of vagina who were primary diagnosed or suspected as anterior vaginal wall prolapse or uterine prolapse by pelvic organ prolapse quantitation (POP-Q) in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Guangzhou Medical University were enrolled as research objects. They were classified into two groups by transperineal ultrasound diagnosed results, anterior pelvic cavity dysfunction group (n=58) and normal anterior pelvic cavity function group (n=10). At the same time, according to whether patients in anterior pelvic cavity dysfunction group were combined with cystocele or not, they were classified into cystocele subgroup (n=28) and without cystocele subgroup (n=30). The parameters of resting and max Valsalva conditions were observed and measured, respectively by transperineal ultrasound, including bladder position, funneling of the internal urethral orifice, bladder neck-symphyseal distance (BSD), vesicourethral angle, the bladder neck descent (BND), rotation angle of urethra and bladder neck. And the cystocele subtypes of patients were classified. The BND, rotation angle of urethra and bladder neck, retrovesical angle of resting and max Valsalva conditions were compared between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group, and with cystocele subgroup, and without cystocele subgroup, respectively by statistical methods. There were no statistical differences among the age, body weight, gravidity, parity and POP-Q degree between anterior pelvic cavity dysfunction group and normal anterior pelvic cavity function group, and with cystocele subgroup and without cystocele subgroup (P>0.05). The research followed the ethical standards of the human trials of the First Affiliated Hospital of Guangzhou Medical University, approved by the committee, and clinical research informed consent was signed by each patient. Results ①Among 68 cases of patients in this research, 58 cases of anterior pelvic cavity dysfunction diseases were diagnosed by transperineal ultrasound based on the position of bladder, BND, vesicourethral angle, rotation angle of urethra and bladder neck. All the 58 cases were stress urinary incontinence (SUI), and there were 10 cases with funneling of bladder neck, 28 cases with cystocele (7 cases with typeⅠ, 10 cases with type Ⅱ, 11 cases with type Ⅲ). The anterior pelvic cavity function of rest 10 cases all were normal. ②The average of vesicourethral angles of resting and max Valsalva conditions of 58 cases of patients in anterior pelvic cavity dysfunction group were 122.2° (113.3°-136.3°) and 137.7° (119.4°-159.2°), respectively, and both were larger than those of 10 cases in normal anterior pelvic cavity function group which was 91.2° (81.3°-99.0°) and 111.0° (88.3°-117.7°), respectively, and both the differences were statistically significant (Z=-3.775, P=0.000; Z=-3.152, P=0.002). But as to the BND, angle rotation of urethra and bladder neck between two groups, there were no statistical differences (P>0.05). ③The BND, rotation angle of urethra and bladder neck in the patients with cystocele subgroup were (26.4±7.3) mm, 64.0° (43.2°-78.9°), 67.7° (42.7°-84.5°), respectively, all were larger than those of patients without cystocele subgroups, which were (14.2±3.6) mm, 15.5° (10.1°-24.9°), 29.6° (26.4°-38.7°), respectively, and all the differences were statistically significant (t=9.090, P=0.000; Z=5.275, P=0.000; Z=5.322, P=0.000). But as to the retrovesical angles of resting and max Valsalva conditions in two subgroups, there were no statistical differences (P>0.05). Conclusions Transperineal ultrasound is a noninvasive, shortcut and more accurate method to observe the anatomical position and function of anterior pelvic cavity. It is useful for the diagnosis of female anterior pelvic cavity dysfunction, and has a great application value. Key words: Ultrasonography; Anterior pelvic cavity dysfunction; Urinary incontinence, stress