The effects of vaginal delivery on urethrovesical junction motility and stress incontinence: ultrasonographic evaluation

Study objective: To evaluate the anatomical changes of the pelvic floor and urinary system following delivery, and to analyse the relationship to mode of delivery and obstetrical procedures. Furthermore, this study aims to discuss and analyse the performance of transperineal sonography of the urethrovesical junction for the diagnosis of female stress urinary incontinence. Methods: Pubovesical angle (PVA) and retrovesical angle (RVA) were evaluated ultrasonographically in controls and pregnant women 24 hours and then 12 weeks after delivery. All patients completed the ICIQ-SF questionnaire. At 24 hours after the delivery, RVA mean values in pregnant women were higher than controls’ and still higher when compared with RVA values after 12 weeks. Results: A linear relationship between PVA modifications and infant weight at birth was demonstrated, as well as between PVA and neonatal biparietal diameter. Besides, the study confirms the occurrence of changes at the urethrovesical junction following disengagement manoeuvres and shoulder dystocia. The role of BMI in affecting the recovery of perineal anatomy after delivery has also been investigated. Conclusion: PVA has shown to be higher in symptomatic women with a cut-off value for the onset of incontinence of 74°, with a sensitivity of 100% and a specificity of 72.5%.