Yang J-M, Yang S-H, Huang W-C
Division of Urogynecology, Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan, ROC.
Ultrasound Obstet Gynecol. 2005 Mar;25(3):289-95. doi: 10.1002/uog.1838.
To evaluate dynamic morphological changes in the anterior vaginal wall in primary urodynamic stress incontinence before and after laparoscopic Burch colposuspension and to explore the related effects on urethral and voiding functions.
Ultrasound cystourethrography and urodynamic study were performed in 112 patients with primary urodynamic stress incontinence before and 3 months after laparoscopic Burch colposuspension. Ultrasound assessment included measurement of the bladder neck positions at rest and during straining, the bladder wall thickness at the dome and trigone, and observation of the motion of the bladder neck in addition to the development of cystocele on Valsalva maneuver. On ultrasonography, a cystocele was defined as prolapse or descent of the bladder base below the bladder neck at rest, on Valsalva, or both.
After laparoscopic Burch colposuspension, ultrasound cystourethrography revealed significant differences in the bladder neck position at rest and during stress (preoperative median 93 degrees vs. postoperative 70 degrees at rest and preoperative 160 degrees vs. postoperative 81 degrees during stress, P < 0.001, respectively) and rotational angle (preoperative median 58 degrees vs. postoperative 10 degrees , P < 0.001). A laparoscopic Burch operation corrected 50% (5/10) of the preoperative cystoceles. However, a residual cystocele developed postoperatively in 29% (30/102) of the women who did not have one previously. Postoperative ultrasonographic and urodynamic studies did not reveal any differences between those women with or without postoperative cystocele except for the residual urine volume, detrusor opening pressure, and straining and rotational angles of the bladder neck (P < 0.001, 0.032, 0.010 and < 0.001, respectively).
Laparoscopic Burch colposuspension may correct a pre-existing cystocele, but in other patients a cystocele may persist or be disclosed. After laparoscopic Burch operation a persistent cystocele is not associated with urethral compression or voiding impairment.
评估腹腔镜Burch阴道悬吊术前后原发性尿动力学压力性尿失禁患者阴道前壁的动态形态变化，并探讨其对尿道及排尿功能的相关影响。
对112例原发性尿动力学压力性尿失禁患者在腹腔镜Burch阴道悬吊术前及术后3个月进行超声膀胱尿道造影和尿动力学研究。超声评估包括静息及用力时膀胱颈位置的测量、膀胱顶部和三角区膀胱壁厚度的测量，以及除Valsalva动作时膀胱膨出的进展情况外，对膀胱颈运动的观察。在超声检查中，膀胱膨出定义为静息、Valsalva动作时或两者均出现膀胱底部脱垂或下降至膀胱颈以下。
腹腔镜Burch阴道悬吊术后，超声膀胱尿道造影显示静息及用力时膀胱颈位置存在显著差异（术前静息时中位数为93度，术后为70度；术前用力时为160度，术后为81度，P均<0.001）以及旋转角度（术前中位数为58度，术后为10度，P<0.001）。腹腔镜Burch手术纠正了50%（5/10）的术前膀胱膨出。然而，29%（30/102）术前无膀胱膨出的女性术后出现了残余膀胱膨出。术后超声及尿动力学研究显示，除残余尿量、逼尿肌开放压、膀胱颈用力及旋转角度外，有或无术后膀胱膨出的女性之间未发现任何差异（P分别为<0.001、0.032、0.010和<0.001）。
腹腔镜Burch阴道悬吊术可能纠正已存在的膀胱膨出，但在其他患者中膀胱膨出可能持续存在或出现。腹腔镜Burch手术后，持续存在的膀胱膨出与尿道压迫或排尿障碍无关。
