Abstract：
OBJECTIVE: Urethral closure mechanism dysfunction in female stress urinary incontinence (SUI) is poorly understood. We aimed to quantify these mechanisms through changes in urethral shape and position during squeeze (voluntary closure) and Valsalva (passive closure) via endovaginal ultrasound in women with varying SUI severity.
METHODS: In this prospective cohort study, 76 women who presented to our tertiary center for urodynamic testing as preoperative assessment were recruited. Urodynamics were performed according to International Continence Society criteria. Urethral pressures were obtained during serial Valsalva maneuvers. Urethral lengths, thicknesses, and angles were measured in the midsagittal plane via dynamic anterior compartment ultrasound. Statistical shape modeling was carried out by a principal component analysis on aligned urethra shapes.
RESULTS: Age, parity, and BMI did not vary by SUI group. Ultrasound detected a larger retropubic angle, urethral knee-pubic bone angle (a novel measure developed for this study), and infrapubic urethral length measurements at Valsalva in women with severe SUI (p = 0.016, 0.015, and 0.010). Shape analysis defined increased \"c\" shape concavity and distal wall pinching during squeeze and increased \"s\" shape concavity and distal wall thickening during Valsalva (p < 0.001). It also described significant urethral shape differences across SUI severity groups (p < 0.001).
CONCLUSIONS: Dynamic endovaginal ultrasound can visualize and allow for quantification of voluntary and passive urethral closure and variations with SUI severity. In women with severe SUI, excessive bladder neck and distal urethra swinging during Valsalva longitudinally compressed the urethra, resulting in a proportionally thicker wall at the mid-urethra and urethral knee.
METHODS: In this prospective cohort study, 76 women who presented to our tertiary center for urodynamic testing as preoperative assessment were recruited. Urodynamics were performed according to International Continence Society criteria. Urethral pressures were obtained during serial Valsalva maneuvers. Urethral lengths, thicknesses, and angles were measured in the midsagittal plane via dynamic anterior compartment ultrasound. Statistical shape modeling was carried out by a principal component analysis on aligned urethra shapes.
RESULTS: Age, parity, and BMI did not vary by SUI group. Ultrasound detected a larger retropubic angle, urethral knee-pubic bone angle (a novel measure developed for this study), and infrapubic urethral length measurements at Valsalva in women with severe SUI (p = 0.016, 0.015, and 0.010). Shape analysis defined increased \"c\" shape concavity and distal wall pinching during squeeze and increased \"s\" shape concavity and distal wall thickening during Valsalva (p < 0.001). It also described significant urethral shape differences across SUI severity groups (p < 0.001).
CONCLUSIONS: Dynamic endovaginal ultrasound can visualize and allow for quantification of voluntary and passive urethral closure and variations with SUI severity. In women with severe SUI, excessive bladder neck and distal urethra swinging during Valsalva longitudinally compressed the urethra, resulting in a proportionally thicker wall at the mid-urethra and urethral knee.
摘要：
目的：对女性压力性尿失禁（SUI）的尿道闭合机制功能障碍知之甚少。我们旨在通过不同SUI严重程度的女性的阴道内超声在挤压（自愿闭合）和Valsalva（被动闭合）过程中尿道形状和位置的变化来量化这些机制。
方法：在这项前瞻性队列研究中，招募了76名到我们的三级中心进行尿动力学检测作为术前评估的女性。根据国际连续性协会标准进行尿动力学。在连续的Valsalva动作中获得了尿道压力。尿道长度,厚度,并通过动态前室超声在矢状面测量角度。通过对对齐的尿道形状进行主成分分析来进行统计形状建模。
结果：年龄，奇偶校验，BMI并没有因SUI组而异。超声检测到耻骨后角较大,尿道膝关节-耻骨角度（为这项研究开发的一种新方法），严重SUI妇女在Valsalva处的耻骨下尿道长度测量（p=0.016、0.015和0.010）。形状分析定义了挤压过程中增加的“c”形状凹度和远端壁挤压以及Valsalva过程中增加的“s”形状凹度和远端壁增厚（p<0.001）。它还描述了SUI严重程度组之间的显着尿道形状差异（p<0.001）。
结论：动态阴道内超声可以可视化并量化自愿和被动尿道闭合以及SUI严重程度的变化。在患有严重SUI的女性中，在Valsalva纵向压缩尿道期间，膀胱颈过度和尿道远端摆动，导致尿道中部和尿道膝盖的壁按比例较厚。
方法：在这项前瞻性队列研究中，招募了76名到我们的三级中心进行尿动力学检测作为术前评估的女性。根据国际连续性协会标准进行尿动力学。在连续的Valsalva动作中获得了尿道压力。尿道长度,厚度,并通过动态前室超声在矢状面测量角度。通过对对齐的尿道形状进行主成分分析来进行统计形状建模。
结果：年龄，奇偶校验，BMI并没有因SUI组而异。超声检测到耻骨后角较大,尿道膝关节-耻骨角度（为这项研究开发的一种新方法），严重SUI妇女在Valsalva处的耻骨下尿道长度测量（p=0.016、0.015和0.010）。形状分析定义了挤压过程中增加的“c”形状凹度和远端壁挤压以及Valsalva过程中增加的“s”形状凹度和远端壁增厚（p<0.001）。它还描述了SUI严重程度组之间的显着尿道形状差异（p<0.001）。
结论：动态阴道内超声可以可视化并量化自愿和被动尿道闭合以及SUI严重程度的变化。在患有严重SUI的女性中，在Valsalva纵向压缩尿道期间，膀胱颈过度和尿道远端摆动，导致尿道中部和尿道膝盖的壁按比例较厚。
