# Comparison of elastography score and strain ratio values according to the presence of stress urinary incontinence in transperineal elastography

## TL;DR

This study found that women with stress urinary incontinence have reduced pelvic floor muscle elasticity compared to continent women, as measured by transperineal elastography.

## Contribution

The study introduces transperineal elastography as a noninvasive tool for evaluating pelvic floor muscle function in stress urinary incontinence.

## Key findings

- Women with SUI had significantly lower elastography scores and strain ratios at rest and during the Valsalva maneuver.
- Transperineal elastography revealed biomechanical dysfunction in pelvic floor tissues among women with SUI.
- The number of vaginal deliveries was higher in the SUI group, suggesting a possible link to pelvic floor damage.

## Abstract

To compare the elastography score (ES) and strain ratio (SR) values in transperineal elastography according to the presence of stress urinary incontinence (SUI).

This retrospective descriptive study included 72 women who underwent transperineal ultrasonographic evaluations of pelvic floor function between January 2020 and April 2022. The study group consisted of 32 women with SUI, and the control group included 40 continent women. Elastography assessments were performed by a single experienced gynecologist using strain elastography focused on the puborectalis portion of the levator ani muscle. The ES was graded on a four-point scale (1 = soft, 4 = hard), and SR values were calculated automatically as the ratio of reference soft tissue to levator ani muscle strain (SR = B/A).

The number of vaginal deliveries was significantly higher in the SUI group (2.4 ± 1.3 vs. 1.3 ± 0.9, p = 0.001). ES values were significantly lower in the SUI group compared with the controls at rest (ES: 1.9 ± 0.8 vs. 2.5 ± 0.8, p = 0.002). SR values were significantly lower in the SUI group compared with the controls at rest (SR: 1.72 ± 0.43 vs. 2.15 ± 0.47, p = 0.001). ES values were significantly lower in the SUI group compared with the controls during the Valsalva maneuver (ES: 2.6 ± 0.6 vs. 3.2 ± 0.5, p = 0.001). SR values were significantly lower in the SUI group compared with the controls during the Valsalva maneuver (SR: 2.94 ± 0.53 vs. 3.79 ± 0.61, p = 0.001).

Transperineal elastography demonstrated a significant reduction in levator ani muscle elasticity in women with SUI. These findings suggest that SUI is an anatomic disorder that involves biomechanical dysfunction of pelvic floor tissues. Transperineal elastography may serve as a noninvasive, reproducible, and objective tool for evaluating pelvic floor muscle function and monitoring treatment outcomes in clinical practice.