Viereck V, Pauer H U, Bader W, Lange R, Viereck N, Emons G, Hilgers R, Hackenberg R, Krauss T
Klinik für Gynäkologie und Geburtshilfe, Georg-August-Universität Göttingen.
Ultraschall Med. 2003 Oct;24(5):340-4. doi: 10.1055/s-2003-42911.
To evaluate the position of the bladder neck before and after open Burch colposuspension, using introital ultrasound.
Retrospective longitudinal study using pre- and post-operative sonographic assessment of the position and function of the bladder neck.
Urogynecology units at the universities of Marburg/Göttingen and Witten/Herdecke and the DRK district hospital in Alzey, Germany.
310 women undergoing open Burch colposuspension for primary genuine stress incontinence between September 1992 and December 2001.
Two-dimensional introitus sonography of the bladder neck prior to, one week and six months after surgery.
The median age at surgery was 55 years (26 - 85). Open colposuspension lead to a 90.0 % (279/310) cure rate at 6 months with only 3.5 % (11/310) of the patients showing persistent micturation problems. A further 11.6 % (36/310) had symptoms of urgency and in 7 patients (2.3 %) a de novo urge-incontinence occurred. Post-operative bladder neck angles and movements at rest and during valsalva manoeuvre were significantly reduced while the resting bladder neck position was significantly elevated (p < 0.0001). Anatomical elevation of the bladder neck after open colposuspension varied between 2 - 39 with a median of 14.3 mm of neck elevation after one week and 9.9 mm at 6 month, respectively. Incontinence surgery lead to a significant reduction of the urethral funneling (p < 0.0001).
In our series, open Burch colposuspension decreased both the bladder neck angle and the linear movement at rest and on valsalva as a result of the surgically stabilized bladder neck. Thus, our results support the hammock hypothesis that even small changes in the position of neck position are sufficient to reverse incontinence. We believe that perioperative introitus sonography is a helpful tool for the clinical assessment and documentation of not only morphological but also functional changes of the female continence organ before and after open Burch colposuspension.
采用阴道超声评估开放性Burch阴道悬吊术前后膀胱颈的位置。
一项回顾性纵向研究，利用术前和术后超声评估膀胱颈的位置和功能。
德国马尔堡/哥廷根大学、维滕/黑尔德克大学的妇科泌尿学科室以及阿尔蔡的德国红十字会地区医院。
1992年9月至2001年12月期间接受开放性Burch阴道悬吊术治疗原发性真性压力性尿失禁的310名女性。
在手术前、术后1周和6个月对膀胱颈进行二维阴道超声检查。
手术时的中位年龄为55岁（26 - 85岁）。开放性阴道悬吊术在6个月时的治愈率为90.0%（279/310），仅有3.5%（11/310）的患者存在持续性排尿问题。另有11.6%（36/310）有尿急症状，7名患者（2.3%）出现新发急迫性尿失禁。术后膀胱颈角度以及静息和瓦尔萨尔瓦动作时的移动明显减少，而静息时膀胱颈位置明显升高（p < 0.0001）。开放性阴道悬吊术后膀胱颈的解剖学抬高在2 - 39之间，术后1周时膀胱颈抬高的中位数为14.3 mm，6个月时为9.9 mm。尿失禁手术导致尿道漏斗形成明显减少（p < 0.0001）。
在我们的研究系列中，开放性Burch阴道悬吊术由于手术固定了膀胱颈，降低了膀胱颈角度以及静息和瓦尔萨尔瓦动作时的线性移动。因此，我们的结果支持吊床假说，即膀胱颈位置的微小变化就足以逆转尿失禁。我们认为围手术期阴道超声不仅是评估和记录开放性Burch阴道悬吊术前后女性控尿器官形态学变化，也是评估和记录功能变化的有用工具。
Zotero 插件