ORIGINAL RESEARCH article
Front. Med.
Sec. Obstetrics and Gynecology
Comparison of Elastography Score and Strain Ratio Values According to the Presence of Stress Urinary Incontinence in Transperineal Elastography
Provisionally accepted
Can Ata1,2*
Ufuk Atlihan3
Tevfik Berk Bildacı1,2
Mehmet Emre Peker3
Mehmet Ozer4
Sercan Kantarcı5Suna Yildirim Karaca6
Alper Ileri5- 1TC Saglik Bakanligi Buca Seyfi Demirsoy Egitim ve Arastirma Hastanesi, Buca, Türkiye
- 2Izmir Demokrasi Universitesi, Karabağlar, Türkiye
- 3TC Saglik Bakanligi Manisa Merkezefendi Devlet Hastanesi, Yunusemre, Türkiye
- 4Erzurum Bolge Egitim ve Arastirma Hastanesi, Erzurum, Türkiye
- 5TC Saglik Bakanligi Saglik Bilimleri Universitesi Tepecik Egitim ve Arastirma Hastanesi, Konak, Türkiye
- 6Bakircay Universitesi Tip Fakultesi, Izmir, Türkiye
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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.
Keywords: Elastography score, Levator ani muscle, Pelvic Floor, Strain ratio, Stress urinary incontinence
Received: 24 Nov 2025; Accepted: 11 Feb 2026.
Copyright: © 2026 Ata, Atlihan, Bildacı, Peker, Ozer, Kantarcı, Karaca and Ileri. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Can Ata
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