产后36个月时，使用经会阴3/4D超声根据肛提肌损伤类型评估单纯性压力性尿失禁。
Evaluation of isolated urinary stress incontinence according to the type of levator ani muscle lesion using 3/4D transperineal ultrasound 36 months post-partum.
作者信息
García Mejido José Antonio, Valdivieso Mejias Pamela, Fernández Palacín Ana, Bonomi Barby María José, De la Fuente Vaquero Paloma, Sainz Bueno José Antonio
机构信息
Obstetrica y Ginecología, Hospital Universitario de Valme, Sevilla, CP: 41014, Spain.
Obstetrica y Ginecología, Hospital Ginemed, Sevilla, Spain.
出版信息
Int Urogynecol J. 2017 Jul;28(7):1019-1026. doi: 10.1007/s00192-016-3208-0. Epub 2016 Nov 21.
INTRODUCTION
Vaginal delivery can lead to pelvic floor disorders. Many authors have described pelvic floor injuries that can predict future defects such as urinary incontinence and pelvic organ prolapse. We propose the assessment of urinary stress incontinence and its association with levator ani muscle (LAM) microtrauma (>20% in the levator hiatus area during Valsalva) and macrotraumas (avulsion) identified by 3/4D transperineal ultrasound (3D-TpUS) 36 months post-partum.
MATERIALS AND METHODS
This was a prospective observational study including 168 nulliparous women. All patients included were nulliparous with singleton gestation in cephalic presentation, at ≥37 weeks and were recruited on the first day after delivery. Thirty-six months after delivery, 3D-TpUS was carried out to identify LAM lesions (macro or micro). Clinical assessment of urinary stress incontinence (USI) was based on the ICIQ-UI-SF test; a simple stress test and urodynamic test were carried out in the same visit.
RESULTS
A total of 105 nulliparous women were studied (51 spontaneous deliveries [SpD] and 54 vacuum-assisted deliveries [VD]). Microtraumas were identified in 35.3% of SpD and 20.4% of VD. Macrotraumas (avulsion) were identified in 9.8% of SpD and 35.2% of VD (p = 0.006). No differences were found in USI between study groups or in relation to the identification of LAM defects (19.2% in the no lesion group, 25% in the macrotrauma and 13.8% in the microtrauma groups; p = not significant). Nor were significant differences found in the results from the different study groups in the International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form (ICIQ-UI SF) test (12.7±2.2 in the no lesion group, 12.5±4.2 in the macrotrauma and 13.25±4.8 in the microtrauma groups; p = NS).
CONCLUSION
No difference was observed in USI between patients with and without LAM lesions (microtrauma or macrotrauma) 36 months post-delivery.
引言
阴道分娩可导致盆底功能障碍。许多作者描述了可预测未来诸如尿失禁和盆腔器官脱垂等缺陷的盆底损伤。我们建议在产后36个月通过经会阴三维/四维超声（3D-TpUS）评估压力性尿失禁及其与肛提肌（LAM）微创伤（瓦尔萨尔瓦动作时提肌裂孔区域>20%）和宏观创伤（撕脱）的关联。
材料与方法
这是一项前瞻性观察性研究，纳入168例未生育女性。所有纳入患者均为单胎头位妊娠且孕周≥37周的未生育女性，于分娩后第一天招募。分娩36个月后，进行3D-TpUS以识别LAM病变（宏观或微观）。压力性尿失禁（USI）的临床评估基于ICIQ-UI-SF测试；在同一次就诊中进行简单压力测试和尿动力学测试。
结果
共研究了105例未生育女性（51例自然分娩[SpD]和54例真空辅助分娩[VD]）。SpD中有35.3%发现微创伤，VD中有20.4%发现微创伤。SpD中有9.8%发现宏观创伤（撕脱），VD中有35.2%发现宏观创伤（p = 0.006）。研究组之间或与LAM缺陷识别相关的USI方面未发现差异（无病变组为19.2%，宏观创伤组为25%，微创伤组为13.8%；p = 无显著性差异）。不同研究组在国际尿失禁咨询委员会尿失禁模块化问卷简表（ICIQ-UI SF）测试结果中也未发现显著差异（无病变组为12.7±2.2，宏观创伤组为12.5±4.2，微创伤组为13.25±4.8；p = 无显著性差异）。
结论
分娩后36个月，有和没有LAM病变（微创伤或宏观创伤）的患者在USI方面未观察到差异。
Zotero 插件