经会阴超声评价尿道角度变化对压力性尿失禁的意义
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摘要
目的探讨尿道倾斜角、膀胱尿道后角、尿道旋转角和膀胱尿道后角旋转角在诊断压力性尿失禁(SUI)中的价值。方法回顾性分析SUI组(有漏尿症状,158例)和对照组(无漏尿症状,150例)女性患者的盆底超声图像,测量静息状态和最大Valsalva状态下尿道倾斜角和膀胱尿道后角,计算出尿道旋转角和膀胱尿道后角旋转角,分析各角度变化与SUI的相关性。结果静息状态下,SUI组与对照组尿道倾斜角差异无统计学意义(P>0.05),SUI组较对照组膀胱尿道后角增大(P<0.05)。最大Valsalva状态下,SUI组尿道倾斜角、膀胱尿道后角、尿道旋转角和膀胱尿道后角旋转角均大于对照组(P<0.05),尿道倾斜角和尿道旋转角诊断SUI的敏感性和特异性均较低。静息状态下膀胱尿道后角>120.9°诊断SUI的敏感性和特异性分别为84.3%和86.7%,Valsalva状态下膀胱尿道后角>144.6°诊断SUI的敏感性和特异性分别为80%和90%。SUI组和对照组在静息状态时近端尿道轴线偏向人体背侧较偏向人体腹侧的尿道旋转角大(P<0.05)。结论经会阴超声可对膀胱颈及尿道的活动度的变化进行量化,对SUI有一定的诊断价值。
Objective To investigate the value of urethral inclination angle, retrovesical angle, urethral rotation angle and rotation angle of retrovesical angle in the diagnosis of stress urinary incontinence(SUI). Methods To retrospectively analyze the transperineal ultrasound pelvic images of female patients between SUI group(with leakage symptom, 158 cases) and control group(without leakage symptom, 150 cases), measure the value of urethral inclination angle and retrovesical angle under resting state and maximal Valsalva state, and calculate urethral rotation angle and rotation angle of retrovesical angle. Then analyze the relativity between changes of each angle and SUI. Results At the resting state, there was no significant difference in the urethral inclination angle between the SUI group and the control group(P > 0.05). Compared with the control group, the retrovesical angle increased in the SUI group(P < 0.05). At maximal Valsalva, urethral inclination angle, retrovesical angle, urethral rotation angle and the rotation angle of retrovesical angle in SUI were greater than control group(P < 0.05). The sensitivity and specificity of both the urethral inclination angle and urethral rotation angle were lower during SUI diagnosis. The sensitivity and specificity of retrovesical angle > 120.9° at restingstate in the diagnosis of SUI were 84.3% and 86.7%, respectively. The sensitivity and specificity of retrovesical angle > 144.6° at the Valsalva state in the diagnosing of SUI were 80% and 90%, respectively. Whether in SUI or control group, the urethral rotation angle of the proximal urethral axis biases at the back of human body was greater than the biases the front of human body(P < 0.05). Conclusion Transperineal ultrasound can quantify the change of activity of bladder neck and urethra, which shows diagnostic value in SUI.
Objective To investigate the value of urethral inclination angle, retrovesical angle, urethral rotation angle and rotation angle of retrovesical angle in the diagnosis of stress urinary incontinence(SUI). Methods To retrospectively analyze the transperineal ultrasound pelvic images of female patients between SUI group(with leakage symptom, 158 cases) and control group(without leakage symptom, 150 cases), measure the value of urethral inclination angle and retrovesical angle under resting state and maximal Valsalva state, and calculate urethral rotation angle and rotation angle of retrovesical angle. Then analyze the relativity between changes of each angle and SUI. Results At the resting state, there was no significant difference in the urethral inclination angle between the SUI group and the control group(P > 0.05). Compared with the control group, the retrovesical angle increased in the SUI group(P < 0.05). At maximal Valsalva, urethral inclination angle, retrovesical angle, urethral rotation angle and the rotation angle of retrovesical angle in SUI were greater than control group(P < 0.05). The sensitivity and specificity of both the urethral inclination angle and urethral rotation angle were lower during SUI diagnosis. The sensitivity and specificity of retrovesical angle > 120.9° at restingstate in the diagnosis of SUI were 84.3% and 86.7%, respectively. The sensitivity and specificity of retrovesical angle > 144.6° at the Valsalva state in the diagnosing of SUI were 80% and 90%, respectively. Whether in SUI or control group, the urethral rotation angle of the proximal urethral axis biases at the back of human body was greater than the biases the front of human body(P < 0.05). Conclusion Transperineal ultrasound can quantify the change of activity of bladder neck and urethra, which shows diagnostic value in SUI.
引文
[1]路会,于诗嘉,史铁梅.超声评价女性压力性尿失禁患者尿道不同分段的移动度[J].中国医学影像技术,2012,28(10):1874—1877
[2]Al-Khuzaee LR,Al-Saadi WI.Perineal ultrasound for evaluating bladder neck and urethra in stress urinary incontinence[J].Iraqi J Med Sci,2012,10:367—374
[3]葛静,鲁永鲜,张弈,等.北京地区成年女性尿失禁患病率及就诊率调查[J].中华妇产科临床杂志,2010,11(1):15—17
[4]蓝建发,潘华,罗新,等.人脐带间充质干细胞移植治疗大鼠压力性尿失禁[J].兰州大学学报:医学版,2017,43(5):1—6
[5]凌锋,郑少波,李虎林,等.三种手术方法治疗前列腺增生症的疗效研究[J].兰州大学学报:医学版,2015,41(4):27—31
[6]Zhang G,Jiang W,Guo Q,et al.Value of UVJ-M in the diagnosis of SUI in late pregnancy and postpartum[J].Exp Ther Med,2016,11(5):1772—1776
[7]Dietz HP,Hoyte LPJ,Steensma AB.Atlas of pelvic floor ultrasound[M].London:Springer-Verlag,2008:67—68
[8]Al-Saadi WI.Transperineal ultrasonography in stress urinary incontinence:the significance of urethral rotation angles[J].Arab J Urol,2016,14(1):66—71
[9]杨焰,钟华,严冬梅,等.盆底超声对产后压力性尿失禁患者前腔室结构的观察[J].中华全科医学,2016,14(8):1262—1265
[10]夏玉光,王红伟,王书亚.二维超声对女性压力性尿失禁的诊断价值[J].临床超声医学杂志,2016,18(1):33—35
[11]陈华,王慧芳.经会阴超声诊断前腔室功能障碍性疾病的临床应用[J].中国介入影像与治疗学,2011,8(5):447—450
[12]王婧霖,侯瑞,吕卓,等.经会阴实时三维超声评价女性压力性尿失禁的应用价值[J].医学影像学杂志,2016,26(10):1867—1869
[13]李婕娜,李淑萍,陈玲,等.女性盆底功能障碍性疾病相关因素及盆底超声测定SUI的临床意义[J].中国妇幼保健,2014,29(14):2147—2149
[14]肖汀,张新玲,杨丽新,等.超声观察膀胱颈在压力性尿失禁诊断中的研究[J].中国超声医学杂志,2016,32(9):822—825
[15]Stone DE,Quiroz LH.Ultrasound imaging of the pelvic floor[J].Obstet Gynecol Clin North Am,2016,43(1):141—153
[2]Al-Khuzaee LR,Al-Saadi WI.Perineal ultrasound for evaluating bladder neck and urethra in stress urinary incontinence[J].Iraqi J Med Sci,2012,10:367—374
[3]葛静,鲁永鲜,张弈,等.北京地区成年女性尿失禁患病率及就诊率调查[J].中华妇产科临床杂志,2010,11(1):15—17
[4]蓝建发,潘华,罗新,等.人脐带间充质干细胞移植治疗大鼠压力性尿失禁[J].兰州大学学报:医学版,2017,43(5):1—6
[5]凌锋,郑少波,李虎林,等.三种手术方法治疗前列腺增生症的疗效研究[J].兰州大学学报:医学版,2015,41(4):27—31
[6]Zhang G,Jiang W,Guo Q,et al.Value of UVJ-M in the diagnosis of SUI in late pregnancy and postpartum[J].Exp Ther Med,2016,11(5):1772—1776
[7]Dietz HP,Hoyte LPJ,Steensma AB.Atlas of pelvic floor ultrasound[M].London:Springer-Verlag,2008:67—68
[8]Al-Saadi WI.Transperineal ultrasonography in stress urinary incontinence:the significance of urethral rotation angles[J].Arab J Urol,2016,14(1):66—71
[9]杨焰,钟华,严冬梅,等.盆底超声对产后压力性尿失禁患者前腔室结构的观察[J].中华全科医学,2016,14(8):1262—1265
[10]夏玉光,王红伟,王书亚.二维超声对女性压力性尿失禁的诊断价值[J].临床超声医学杂志,2016,18(1):33—35
[11]陈华,王慧芳.经会阴超声诊断前腔室功能障碍性疾病的临床应用[J].中国介入影像与治疗学,2011,8(5):447—450
[12]王婧霖,侯瑞,吕卓,等.经会阴实时三维超声评价女性压力性尿失禁的应用价值[J].医学影像学杂志,2016,26(10):1867—1869
[13]李婕娜,李淑萍,陈玲,等.女性盆底功能障碍性疾病相关因素及盆底超声测定SUI的临床意义[J].中国妇幼保健,2014,29(14):2147—2149
[14]肖汀,张新玲,杨丽新,等.超声观察膀胱颈在压力性尿失禁诊断中的研究[J].中国超声医学杂志,2016,32(9):822—825
[15]Stone DE,Quiroz LH.Ultrasound imaging of the pelvic floor[J].Obstet Gynecol Clin North Am,2016,43(1):141—153