Tan Yu Hwee, Gillor Moshe, Dietz Hans Peter
Robina Hospital, 2 Bayberry Lane, Robina, QLD, Australia.
Department of Urogynaecology, Varsity Lakes Day Hospital, 2 Lake Street, Varsity Lakes, QLD, 4227, Australia.
Int Urogynecol J. 2022 Feb;33(2):337-342. doi: 10.1007/s00192-021-04811-0. Epub 2021 May 4.
The primary aim of this study was to assess for an association between maximal intra-abdominal pressure reached on Valsalva (MAP) and pelvic organ prolapse (POP) on subjective, clinical and sonographic evaluation. Another objective was to test for association between MAP and body mass index (BMI).
A retrospective cross-sectional study was carried out on 504 archived datasets of women seen for pelvic floor dysfunction symptoms between January 2017 to September 2019 at a tertiary urogynaecology clinic. Patients underwent a standardized interview including use of visual analogue scores (VAS) to evaluate bother of pelvic floor symptoms, examination using the International Continence Society Pelvic Organ Prolapse Quantification (ICS POP-Q), dual-channel filling and voiding cystometry, test for MAP as well as four-dimensional (4D) transperineal ultrasound. Analysis of ultrasound volumes for pelvic organ descent was performed blinded against all other data.
There was a weak but significant association between MAP and sonographic rectal ampulla descent (p = 0.0275). There was also a significant association between MAP and bother of obstructed defecation symptoms (p = 0.0065). Symptomatic, clinical and sonographic POP in the anterior or the apical compartments was not significantly associated with MAP. On multivariate analysis, the association between MAP and rectal descent remained significant (p = 0.01). There was no significant association between BMI and MAP.
This cross-sectional study showed an association between MAP and posterior compartment prolapse on imaging as well as between MAP and the bother score of obstructed defecation symptoms. There was no association between BMI and MAP.
本研究的主要目的是通过主观、临床和超声评估，探讨瓦尔萨尔瓦动作时达到的最大腹内压（MAP）与盆腔器官脱垂（POP）之间的关联。另一个目的是检验MAP与体重指数（BMI）之间的关联。
对2017年1月至2019年9月在一家三级泌尿妇科诊所因盆底功能障碍症状就诊的504名女性的存档数据集进行回顾性横断面研究。患者接受标准化访谈，包括使用视觉模拟评分（VAS）评估盆底症状的困扰程度，采用国际尿控协会盆腔器官脱垂定量法（ICS POP-Q）进行检查、双通道充盈和排尿膀胱测压、MAP检测以及四维（4D）经会阴超声检查。对盆腔器官下降的超声容积分析是在对所有其他数据不知情的情况下进行的。
MAP与超声检查显示的直肠壶腹下降之间存在微弱但显著的关联（p = 0.0275）。MAP与排便梗阻症状的困扰程度之间也存在显著关联（p = 0.0065）。前盆腔或顶盆腔有症状的、临床诊断的和超声检查发现的POP与MAP之间无显著关联。多因素分析显示，MAP与直肠下降之间的关联仍然显著（p = 0.01）。BMI与MAP之间无显著关联。
这项横断面研究表明，MAP与影像学上的后盆腔脱垂以及MAP与排便梗阻症状的困扰评分之间存在关联。BMI与MAP之间无关联。
