The clinical value of real-time three-dimensional pelvic floor ultrasound in the evaluation of the efficacy of electrical stimulation biofeedback combined with pelvic floor muscle exercise in the treatment of postpartum stress urinary incontinence in primiparas

Ye Qiting; Wu Siqi; He Jiahui; Wu Ximei; Zhang Caihua; Chen Haixia; Huang Xiaoling

doi:10.3969/j.issn.1674-3245.2025.02.032

Abstract：Objective To explore the clinical value of real-time three-dimensional pelvic floor ultrasound in the evaluation of the efficacy of electrical stimulation biofeedback combined with pelvic floor muscle exercise in the treatment of postpartum stress urinary incontinence(PSUI)in primiparas.Methods The clinical data of 100 primiparas with PSUI treated in the Fifth People's Hospital of Nanhai District of Foshan City from June 2022 to February 2024 were retrospectively analyzed.All patients were treated with electrical stimulation biofeedback combined with pelvic floor muscle exercise rehabilitation.After 3 months of treatment,according to the curative effect,the patients were divided into effective group(n=66)and ineffective group(n=34).The clinical data[general information,1 h urine leakage,pelvic floor muscle strength and International Consultative Committee on Urinary Incontinence Questionnaire-Short Form(ICIQ-SF)score]and real-time three-dimensional pelvic floor ultrasound parameters[levator hiatus area during Valsalva maneuver,posterior horn of bladder during Valsalva maneuver,bladder neck mobility and internal urethral orifice funnel formation]were compared between the two groups before and after treatment.Pearson correlation analysis was used to analyze the correlation between ultrasound parameters and pelvic floor muscle strength and ICIQ-SF after treatment.The receiver operating characteristic(ROC)curve was drawn,and the area under the curve(AUC)was used to evaluate the evaluation value of each ultrasound parameter on the efficacy of PSUI patients after treatment.Results The urine leakage volume at 1 h after treatment in the effective group was(2.59±0.46)ml,which was significantly less than(5.74±1.36)ml in the ineffective group(t=17.081,P＜0.05).The pelvic floor muscle strength was(3.89±0.46),which was higher than(2.91±0.72)in the control group(t=8.272,P＜0.05).The ICIQ-SF score was(9.18±1.47),which was lower than(14.59±1.81)in the control group(t=16.092,P＜0.05).After treatment,the area of levator hiatus,posterior bladder angle,bladder neck mobility and internal urethral funnel formation in Valsalva state in the effective group were significantly decreased(t=3.935,5.988,6.332,x2=10.962,P＜0.05).In the ineffective group,the bladder neck mobility decreased(t=2.643,P＜0.05),and other parameters did not change significantly(P＞0.05).The decrease of ultrasound parameters in the effective group was higher than that in the ineffective group(t=3.382,4.708,2.202,x2=5.985,P＜0.05).Pearson correlation analysis showed that Valsalva levator hiatus area,Valsalva bladder posterior angle,bladder neck mobility and urethral funnel formation in the effective group were negatively correlated with pelvic floor muscle strength(r=-0.629,-0.559,-0.586,-0.731,P＜0.05),and positively correlated with ICIQ-SF score(r=0.842,0.784,0.647,0.682,P＜0.05).ROC curve showed that the AUC of Valsalva levator hiatus area,Valsalva bladder posterior angle,bladder neck mobility and urethral funnel formation were 0.812,0.748,0.841 and 0.627,respectively.The AUC was the highest when each index was combined,which was 0.940,and the sensitivity and specificity were 94.12％ and 83.33％..Conclusion Real-time three-dimensional pelvic floor ultrasound has high clinical value in evaluating the efficacy of electrical stimulation biofeedback combined with pelvic floor muscle exercise in the treatment of primary spontaneous delivery PSUI.