Ureteral peristalsis
Automated tracking and quantification of pelvic floor motion in tranperineal ultrasound for urinary incontinence
Pelvic floor mobility plays a key role in urinary incontinence, and transperineal ultrasound (TPUS) can clearly visualize this motion. However, its quantification has largely relied on manual analysis, limited to only a small portion of the visible movement — one of the main reasons TPUS has not been widely adopted in clinical practice. In this study, we developed a fully automated method to quantify pelvic floor mobility in TPUS in real time. This approach captures pelvic floor dynamics with high reliability, providing a noninvasive, efficient, and reproducible tool to support the diagnosis and personalized treatment of urinary incontinence.
Schematic representation (left) and typical transperineal B-mode ultrasound image (right) of the female pelvic floor. S (superior), I (inferior), P (posterior), and A (anterior) are showing anaotmical directions.
This cine loop presents a typical transperineal ultrasound (TPUS) imaging of the female pelvic floor in the midsagittal plane. The bladder, urethra, pubis, and surrounding structures are visualized, illustrating the anatomical orientation used for urethral mobility analysis.
This video demonstrates the automated tracking of urethral motion in response to a Valsalva maneuver. In this example, the urethra is represented by three ROIs; proximal to the bladder (orange), mid-urethra (green) and distal to the bladder (red). A blue ROI on the pubis serves as a reference to correct for probe motion. Feature points used for tracking are overlaid as well.
This video illustrates the motion trajectory of the urethra during the same Valsalva maneuver as in the above videos, analyzed in the inferior pubic point (IPP) coordinate system. The trajectories of the proximal (orange), mid (green), and distal (red) urethral ROIs are visualized on a blank canvas, showing their displacement over time. The pubic ROI remains fixed as a reference, allowing urethral motion to be analyzed relative to the IPP.
Our vision for advancing the diagnosis and treatment of urinary incontinence is to generate automated, intuitive reports that summarize pelvic floor dynamics from transperineal ultrasound. This sample report illustrates key metrics—such as segmental displacements, motion trajectories, and urethral rotation—captured in real time. By translating complex motion into actionable data, this approach enables personalized treatment planning and lays the groundwork for future clinical decision support tools.
Related Publications
[1] K. Kalayeh, J. B. Fowlkes, B. S. Sack, J. LaCross, S. Daignault-Newton, P. Schmidt, H. Tai, W. W. Schultz, J. A. Ashton-Miller and J. O. DeLancey, “A New Automated Ultrasound Quantification of Urethral Mobility for Stress Urinary Incontinence: A Feasibility Study.,” J Ultrasound Med, 2025. https://www.ncbi.nlm.nih.gov/pubmed/40095237