Martan A, Masata J, Halaska M, Otcenásek M, Svabik K
Department of Obstetrics and Gynecology, Charles University, Prague, Czech Republic.
Ultrasound Obstet Gynecol. 2002 May;19(5):496-500. doi: 10.1046/j.1469-0705.2002.00686.x.
The aim of our study was to analyze whether transabdominal and introital sonography can identify paravaginal defects and to determine changes that occur following paravaginal defect repair and Burch colposuspension.
Twenty women with genuine stress incontinence took part in this prospective study. The mobility of the bladder neck was assessed transperineally with a curved array probe following instillation of 300 mL saline. The same probe was used transabdominally to determine the presence of paravaginal defects. Introital examination using a transvaginal probe was then performed to determine the presence of paravaginal defects. The same measurements were performed following Burch colposuspension and paravaginal defect repair.
There were significant differences in bladder neck position and mobility before and after surgical intervention. In 18 women before surgery, transabdominal ultrasound identified unilateral or bilateral paravaginal defects. Eight unilateral defects were found on the right side but only two were found on the left side. In eight women, the defect was bilateral. The introital approach obtained similar results apart from in two patients with a bilateral defect in whom it indicated a unilateral right defect. Between the first and second weeks following the operation transabdominal ultrasound found no paravaginal defects in 16 women and introital ultrasound found no paravaginal defects in 18 women. We were unable to visualize the region of the paravaginal defect in two women using transabdominal ultrasound because the abdominal wall was edematous after surgery. Five to 6 weeks after the operation, our results were confirmed by abdominal and introital ultrasound in all cases. No paravaginal defects were found in any of the patients after paravaginal defect repair.
Our clinical study suggests that ultrasound scanning should be performed to confirm the presence of paravaginal defects and that paravaginal defect repair may be added to Burch colposuspension for the treatment of genuine stress incontinence, as an operation to correct cystourethrocele and the posterior urethrovesical angle.
我们研究的目的是分析经腹超声和经阴道超声能否识别阴道旁缺陷，并确定阴道旁缺陷修复术和Burch阴道悬吊术后发生的变化。
20名真性压力性尿失禁女性参与了这项前瞻性研究。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。使用同一探头经腹检查以确定是否存在阴道旁缺陷。然后使用经阴道探头进行阴道内检查以确定阴道旁缺陷的存在。在Burch阴道悬吊术和阴道旁缺陷修复术后进行相同的测量。
手术干预前后膀胱颈位置和活动度存在显著差异。术前18名女性经腹超声发现单侧或双侧阴道旁缺陷。右侧发现8个单侧缺陷，左侧仅发现2个。8名女性存在双侧缺陷。除2名双侧缺陷患者经阴道检查提示单侧右侧缺陷外，经阴道检查获得了相似结果。术后第1周和第2周之间，16名女性经腹超声未发现阴道旁缺陷，18名女性经阴道超声未发现阴道旁缺陷。两名女性经腹超声无法观察到阴道旁缺陷区域，因为术后腹壁水肿。术后5至6周，所有病例经腹和经阴道超声均证实了我们的结果。阴道旁缺陷修复术后所有患者均未发现阴道旁缺陷。
我们的临床研究表明，应进行超声扫描以确认阴道旁缺陷的存在，并且对于真性压力性尿失禁的治疗，可在Burch阴道悬吊术基础上加做阴道旁缺陷修复术，作为纠正膀胱尿道膨出和后尿道膀胱角的手术。
