TRANS PERINEAL ULTRASOUND IN FEMALE STRESS URINARY INCONTINENCE: THE SIGNIFICANCE OF URETHRAL ROTATION

Background: Urinary incontinence is a widespread and serious problem in women. Incontinence can disrupt social life, physical exercise, and sexual activity, impacting emotional and psychological well-being. Stress urinary incontinence may only be effectively treated with a thorough understanding of its etiology, pathophysiology, precise diagnosis, and range of therapeutic choices from which a personalized treatment plan can be developed. Aims: To study the role of trans perineal ultrasound in the assessment of pelvic floor and urethral rotation in female with urinary stress incontinence. Methods: This is an observational, descriptive, hospital-based, case control study was conducted on 30 women having stress urinary incontinence and 30 continent women as a control group. It was conducted at Al-Imamain Al-Khadhimain Medical City, from March 1, 2025, to December 31, 2025. Ladies with neuropsychiatric or cognitive disorders, those with diabetes, previous urogenital surgery, pelvic irradiation, genitourinary tumors, pelvic organ prolapse, urinary tract infection, and patients who took medication that could cause urinary incontinence were excluded from the study. Results: The mean age ± standard deviation of the study participants was 58.46 ± 9.51 years, while the patients’ range of ages was (29-79) years. Statistically significant difference between patients and controls regarding their α angle at Valsalva (P value <0.001), β angle at Valsalva (P value <0.001), α urethral rotation angle (P value <0.001), β urethral rotation angle (P value <0.001) and mean of bladder neck descends (P value <0.001). While no statistically significant difference between them with regard to α angle at rest (P value = 0.493) and β angle at rest (P value = 0.379). Bladder neck descent (mm) was found as the strongest predictor for stress urinary incontinence (odds ratio = 2.5956, CI = 1.249 – 9.321, P value <0.001), followed by β urethral rotation angle (odds ratio = 1.7097, CI = 1.093-2.673, P value = 0.001) and α urethral rotation angle (odds ratio = 1.2875, CI = 1.096-1.511, P value = 0.002). The sensitivity values varied from 65% for α urethral rotation angle to 95% for bladder neck descent, while specificity varied from 74.07% for α urethral rotation angle to 95.23% for bladder neck descent. Furthermore, the positive predictive value ranged between 65% and 95%, with the lowest values found for urethral rotation parameters and the highest for bladder neck descent and α angle at Valsalva. While, the negative predictive value showed consistently high performance, ranging between 89.5% to 100%. The diagnostic accuracy ranged from 82.5% to 97.5%, with bladder neck descent demonstrating the highest accuracy among all assessed parameters, followed by α urethral angle at Valsalva and β urethral rotation angle. Conclusions: Trans-perineal pelvic floor ultrasonography is a useful, non-invasive imaging technique for the assessment and diagnosis of stress urine incontinence. Ultrasonographic parameters examined during the Valsalva maneuver were considerably more informative than those obtained at rest.