目的:探讨经会阴4D超声(TPUS)参数对压力性尿失禁(SUI)中尿道活动过度(UH)和固有括约肌缺乏症(ISD)的鉴别诊断。
方法:观察性研究。研究地点和持续时间:苏州大学附属第二医院,中国,从2018年1月到2022年1月。
方法:根据valsalva泄漏点压力(VLPP),绝经后SUI妇女分为UH和ISD组,以健康妇女为对照组。分析了医学数据和超声参数对SUI的诊断价值。
结果:在患有SUI的女性中,身体质量指数,奇偶校验,尿道漏斗形成率,膀胱颈下降(BND),最大Valsalva动作(MVM)下的后膀胱角(RVA),尿道旋转角(URA)和提上肌裂孔面积(LHA)较高,但膀胱颈内角(BIA),静息时尿道长度(UL)和MVM下尿道长度(UL)小于对照组(p<0.05)。在UH组中,BIA,BND,MVM下的UL更高,但ICIQ-SF评分和尿道漏斗形成率均小于ISD组,膀胱膨出与格林的类型有显著差异(p<0.05)。较小的BIA,MVM下的UL较短,更高的ICIQ-SF评分更有可能诊断ISD,而GreenII型囊肿可能诊断为UH(p<0.05)。Logistic回归模型的受试者操作特征曲线下面积为0.864,敏感性为90.6%,特异性为71.9%。MVM下VLPP与BIA、UL呈正相关,与ICIQ-SF评分呈负相关。
结论:4DTPUS的参数可以区分SUI中的UH和ISD。
背景:压力性尿失禁,经会阴超声,Valsalva泄漏点压力,尿道过度活动,固有括约肌缺陷。
OBJECTIVE: To explore 4D transperineal ultrasound (TPUS) parameters distinguishing urethral hypermobility (UH) and intrinsic sphincter deficiency (ISD) in stress urinary incontinence (SUI).
METHODS: Observational study. Place and Duration of the Study: The Second Affiliated Hospital of Soochow University,
China, from January 2018 to January 2022.
METHODS: According to valsalva leak point pressure (VLPP), postmenopausal SUI women were divided into UH and ISD groups, and healthy women were set as control group. Medical data and ultrasound parameters were analysed for their diagnostic values on SUI.
RESULTS: In women with SUI, body mass index, parity, urethral funnel formation rate, bladder neck descent (BND), retrovesical angle (RVA) under the maximum valsalva manoeuver (MVM), urethral rotation angle (URA) and levator hiatus area (LHA) were higher, but bladder neck internal angle (BIA), urethral length (UL) at rest and UL under MVM were smaller than those in control (p<0.05). In the UH group, BIA, BND, and UL under MVM were higher, but ICIQ-SF score and urethral funnel formation rate were smaller than those in the ISD group, and
Cystocele Green\'s type differed significantly (p<0.05). Smaller BIA, shorter UL under MVM, and higher ICIQ-SF score were more likely to diagnose ISD, while
Cystocele Green\'s type II were likely to diagnose UH (p<0.05). The area under receiver operator characteristic curve of the logistic regression model was 0.864 with 90.6% sensitivity and 71.9% specificity. VLPP was positively correlated with BIA and UL under MVM but negatively correlated with the ICIQ-SF score.
CONCLUSIONS: Parameters of 4D TPUS can differentiate UH and ISD in SUI.
BACKGROUND: Stress urinary incontinence, Transperineal ultrasound, Valsalva leak point pressure, Urethral hypermobility, Intrinsic sphincter deficiency.