Martan A, Masata J, Halaska M, Voigt R
Department of Obstetrics and Gynecology, Charles University, Unemocnice 2, 128 00 Prague 2, Czech Republic.
Ultrasound Obstet Gynecol. 2001 Jan;17(1):58-64. doi: 10.1046/j.1469-0705.2001.00301.x.
Most of the relevant surgical procedures employed in the management of genuine stress urinary incontinence (GSI) involve the technique of bladder neck elevation. The appropriate level of suspension is an important (but frequently overlooked) consideration as the clinical consequences of over-correction of the posterior angle are voiding dysfunction and urgency symptoms. The aim of our study was to compare ultrasound characteristics in women with GSI with those of women before and after Burch colposuspension. The findings of our study should have implications for GSI management.
Prospective randomized clinical study at the Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic.
Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic.
Seventy women with previously untreated GSI (preoperative group) and 52 women (42 of whom had been in the preoperative group) who were studied 3-12 months after receiving Burch colposuspension (postoperative group) took part in the study. The standard transperineal and introital ultrasound scans were performed. The mobility of the bladder neck was assessed transperineally with a curved array probe after instillation of 300 mL of saline. The bladder was then evacuated and the thickness of the urinary bladder wall in the sagittal plane in defined regions (base, vertex and anterior wall) was measured.
We found significant differences in bladder neck position, mobility, and in bladder wall thickness. Where symptoms of urgency occurred, the average bladder wall thickness was > 5 mm, the gamma angle < 40 degrees, and lower bladder neck mobility was evident.
These findings supported our hypothesis that signs of urgency follow over-elevation of the bladder neck. These results helped us significantly to refine our GSI management.
真性压力性尿失禁（GSI）管理中采用的大多数相关外科手术都涉及膀胱颈抬高技术。合适的悬吊水平是一个重要（但常被忽视）的考虑因素，因为后角过度矫正的临床后果是排尿功能障碍和尿急症状。我们研究的目的是比较GSI女性与接受Burch阴道悬吊术前后女性的超声特征。我们的研究结果应对GSI的管理具有启示意义。
在捷克共和国布拉格查理大学妇产科进行的前瞻性随机临床研究。
捷克共和国布拉格查理大学妇产科。
70名未经治疗的GSI女性（术前组）和52名女性（其中42名曾在术前组）参与了研究，后者在接受Burch阴道悬吊术3至12个月后接受研究（术后组）。进行了标准的经会阴和阴道内超声扫描。在注入300 mL生理盐水后，使用弯阵探头经会阴评估膀胱颈的活动度。然后排空膀胱，并测量矢状面特定区域（底部、顶部和前壁）的膀胱壁厚度。
我们发现膀胱颈位置、活动度和膀胱壁厚度存在显著差异。出现尿急症状时，平均膀胱壁厚度>5 mm，γ角<40度，且膀胱颈活动度明显降低。
这些发现支持了我们的假设，即尿急症状是膀胱颈过度抬高所致。这些结果有助于我们显著优化GSI的管理。
