Strain elastography (SE) will be utilized as a non-invasive imaging technique to evaluate
tissue elasticity and biomechanical properties in women with stress urinary incontinence
(SUI) and in continent controls. The primary aim is to determine whether SE can detect
differences in paraurethral tissue stiffness between these groups. Given the established
role of tissue elasticity in the pathophysiology of SUI, SE will be investigated as a
potential diagnostic tool in urogynecological evaluations.
This prospective cohort study will be conducted at a tertiary referral center. All
participants will undergo introital two-dimensional (2D) ultrasound in the midsagittal
plane at rest. SE will be performed in three predefined suburethral regions of interest
(ROIs):
The adipose layer (AL) between the external urethral meatus and the pubic symphysis will
serve as the reference tissue, representing the softest anatomical structure in the
region.
Descriptive and comparative statistical analyses will be conducted to assess differences
in paraurethral tissue stiffness between the study groups.
It is hypothesized that SE will be able to detect differences in paraurethral tissue
elasticity, with SUI being associated with increased tissue compliance. The study also
aims to determine whether SE can reliably distinguish between varying degrees of tissue
stiffness in women with SUI and continent controls.
Pathophysiological focus:
The study will explore key mechanisms underlying SUI, including:
Weakened bladder neck support
Impaired urethral stabilization due to increased tissue elasticity and collagen
degradation
While conventional 2D ultrasound provides anatomical information, it does not
directly evaluate tissue biomechanics. In contrast, SE enables real-time
visualization of tissue elasticity, offering a promising adjunct to traditional
urogynecological assessment methods.
Standardization and Protocol
The study will follow a standardized protocol to ensure reproducibility and high-quality
data. Key methodological elements include:
Minimal probe compression during introital ultrasound to avoid artifacts
Bladder emptying prior to examination to eliminate confounding effects
Carefully standardized ROI placement across all patients
Controlled image acquisition conditions to reduce variability
Future Directions
Future research based on this study will aim to:
Optimize SE protocols and refine ROI placement strategies
Establish clinical cutoff values for differentiating tissue stiffness in SUI vs.
continent women
Assess the long-term effects of pelvic floor muscle training (PFMT) and vaginal
estrogen therapy on paraurethral biomechanics
Facilitate the integration of SE into routine urogynecological practice to support
early diagnosis and personalized treatment strategies for SUI