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

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