Yousuf Aisha, Chen Luyun, Larson Kindra, Ashton-Miller James A, DeLancey John O L
Department of Obstetrics and Gynecology (Pelvic Floor Research Group), University of Michigan Hospital, Ann Arbor, MI, 48109, USA.
Int Urogynecol J. 2014 Oct;25(10):1349-56. doi: 10.1007/s00192-014-2372-3. Epub 2014 Apr 16.
In cystoceles, the distal anterior vaginal wall (AVW) bulges out through the introitus and is no longer in contact with the posterior vaginal wall or perineal body, exposing the pressure differential between intra-abdominal pressure and atmospheric pressure. The goal of this study is to quantify the length of the exposed vaginal wall length and to investigate its relationship with other factors associated with the AVW support, such as most dependent bladder location, apical location, and hiatus diameter, demonstrating its key role in cystocele formation.
Fifty women were selected to represent a full spectrum of AVW support. Each underwent supine, dynamic MR imaging. Most dependent bladder location and apical location were measured relative to the average normal position on the mid-sagittal plane using the Pelvic Inclination Correction System . The length of the exposed AVW and the hiatus diameter were measured as well. The relationship between exposed AVW and most dependent bladder location, apical location, and hiatus diameter were examined.
A bilinear relationship has been observed between exposed vaginal wall length and most dependent bladder location (R(2) = 0.91, P < 0.001). When the bladder descents up to the inflection point (about 4.4 cm away from its normal position), there is little change in the exposed AVW length. With further descent, the exposed vaginal wall length increases significantly, with a 2 cm increase in exposed AVW length for every additional 1 cm of drop bladder location. A similar but weaker bilinear relationship exists between exposed AVW and apical location. Exposed vaginal wall length is also highly correlated with hiatus diameter (R(2) = 0.85, P < 0.001).
A bilinear relationship exists between exposed vaginal wall length and most dependent bladder location and apical location. It is when the bladder descent is beyond the inflection point that exposed vaginal wall length increases significantly.
在膀胱膨出中，阴道前壁远端通过阴道口膨出，不再与阴道后壁或会阴体接触，从而暴露了腹腔内压力与大气压之间的压力差。本研究的目的是量化暴露的阴道壁长度，并研究其与阴道前壁支撑相关的其他因素（如膀胱最下垂位置、顶端位置和裂孔直径）之间的关系，以证明其在膀胱膨出形成中的关键作用。
选择50名女性以代表阴道前壁支撑的全谱范围。每位女性均接受仰卧位动态磁共振成像。使用骨盆倾斜校正系统在正中矢状面上相对于平均正常位置测量膀胱最下垂位置和顶端位置。同时测量暴露的阴道前壁长度和裂孔直径。检查暴露的阴道前壁与膀胱最下垂位置、顶端位置和裂孔直径之间的关系。
观察到暴露的阴道壁长度与膀胱最下垂位置之间存在双线性关系（R(2) = 0.91，P < 0.001）。当膀胱下降至拐点（距其正常位置约4.4 cm）时，暴露的阴道前壁长度变化不大。随着进一步下降，暴露的阴道壁长度显著增加，膀胱位置每下降1 cm，暴露的阴道前壁长度增加2 cm。暴露的阴道前壁与顶端位置之间存在类似但较弱的双线性关系。暴露的阴道壁长度也与裂孔直径高度相关（R(2) = 0.85，P < 0.001）。
暴露的阴道壁长度与膀胱最下垂位置和顶端位置之间存在双线性关系。当膀胱下降超过拐点时，暴露的阴道壁长度会显著增加。
