Lower urinary tract symptoms (LUTS) and their impact on quality of life are commonly assessed using validated patient-reported questionnaires, including OABSS, ICIQ-SF, UDI-6, I-QOL, and IIQ-7. Ultrasound provides objective measurements of the urethra and bladder neck, often guiding surgical management, but the relationship between these anatomical parameters and patients’ subjective symptom burden remains unclear. Understanding this association is crucial for optimizing preoperative assessment and postoperative evaluation in women undergoing surgery for stress or mixed urinary incontinence. The aim of this study was to evaluate the correlation between ultrasound-derived anatomical parameters and patient-reported outcomes before and one month after surgical treatment, to determine whether structural measurements reflect symptom severity and quality of life.

This was a prospective observational study including 100 women undergoing surgical correction for SUI. Participants were evaluated both preoperatively and one month postoperatively. Objective anatomical measurements of the urethra and bladder neck were obtained using transperineal ultrasound at rest and during Valsalva maneuver. Patient-reported outcomes, including OABSS, ICIQ-SF, UDI-6, I-QOL, and IIQ-7, were collected at the same time points. The sample size was determined to detect clinically meaningful changes in both anatomical parameters and patient-reported outcomes before and after surgery, with a statistical power of ≥80% and a significance level of 0.05. Considering expected effect sizes and variability, a minimum of 90–100 participants was required.

Mean age of 51.9 ± 11.6 years (range 27–86), mean body weight of 76.4 ± 16.0 kg (range 45–170), and mean BMI of 28.3 ± 4.6 kg/m² (range 18.3–42.4). The mean duration of urinary symptoms was 6.4 ± 5.5 years (0–30 years).
Postoperatively, urethral length at rest increased from 32.22 ± 6.03 mm to 33.72 ± 5.19 mm (Z = -2.187, p = 0.029) and during Valsalva from 29.44 ± 8.95 mm to 30.79 ± 9.39 mm (Z = -1.978, p = 0.048). The distance from the symphysis to mid-urethra decreased at rest from 11.68 ± 4.29 mm to 10.39 ± 3.33 mm (Z = -2.647, p = 0.008) and during Valsalva from 13.05 ± 4.89 mm to 11.39 ± 4.21 mm (Z = -3.408, p = 0.001). The α-angle deviation during Valsalva decreased from 47.40 ± 29.74° to 43.88 ± 32.47° (Z = -3.787, p < 0.001), whereas the α-angle at rest showed no significant change. Other structural parameters—including urethral diameter, distance from symphysis to bladder neck, and posterior urethrovesical β-angle—remained largely unchanged. Postoperatively, 67 of 100 patients reported decreased OABSS scores, all 100 had lower ICIQ-SF scores, and 99 showed reduced UDI-6 scores. Quality of life improved, with 97 patients showing higher I-QOL and IIQ-7 scores. All changes were statistically significant (p < 0.001), reflecting substantial symptomatic relief and enhanced quality of life. Spearman correlation analysis between ultrasound parameters and questionnaire scores, pre- and postoperatively, revealed mostly non-significant associations. Only isolated weak correlations were observed, such as postoperative β-angle with IIQ-7 scores (r = 0.237, p = 0.018) and postoperative urethral diameter during Valsalva with UDI-6 (r = 0.206, p = 0.045).

Surgical intervention primarily affected urethral length, mid-urethra position, and dynamic α-angle behavior. Ultrasound-based anatomical measurements alone do not reliably represent patient-reported LUTS severity or quality of life, highlighting a disconnect between structural assessments and subjective symptom burden.

Surgical correction of SUI significantly improves patient-reported symptoms and quality of life, while ultrasound-assessed anatomical changes are limited to urethral length, mid-urethra position, and α-angle dynamics. Most other structural parameters remain unchanged, and anatomical measurements do not consistently correlate with symptom severity. These findings emphasize the importance of including validated patient-reported outcomes in the evaluation of treatment effectiveness.