Jiang Changqin, Zhang Song, Chen Jing, Zhang Yangyang, Cai Keke, Chen Wei, Wu Yuanyuan, Liang Chaozhao
Department of Urology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
The Institute of Urology, Anhui Medical University, Hefei, China.
Front Surg. 2023 Jul 21;10:1126293. doi: 10.3389/fsurg.2023.1126293. eCollection 2023.
Stress urinary incontinence (SUI) that has been associated with abnormal pelvic floor muscle function or morphology is a common condition. This research aimed to study the impact of the four-dimensional (4D) pelvic floor ultrasound on the treatment of female patients with clinical diagnosis of SUI and to evaluate its clinical significance on SUI.
We enrolled 51 women with SUI. Before transobturator suburethral tape procedures, the patients underwent 4D pelvic floor ultrasonography. The measurements include residual urine volume, bladder detrusor thickness in resting state, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis at rest and Valsalva movement, posterior angle of bladder urethra, and urethral rotation angle. The degree of movement of the bladder neck (the difference between the vertical distance from the bladder neck to the posterior inferior edge of the pubic symphysis under the resting state and the maximum Valsalva movement) and the formation of a funnel at the internal orifice of the urethra were calculated.
The mean bladder detrusor thickness was 2.6 ± 0.9 mm, the vertical distance from the bladder neck to the posterior inferior edge of pubic symphysis was 27.7 ± 4.5 mm, the posterior angle of the bladder was 122.7 ± 18.9°, the vertical distance from the rectal ampulla to the posterior inferior edge of pubic symphysis was 18.5 ± 4.6 mm, and the mean area of hiatus of the levator ani muscle was 22.1 ± 6.0 cm. The mean posterior angle of the bladder on Valsalva was 159.3 ± 23.1°, and the mean urethral rotation angle was 67.2 ± 21.4°.
The 4D pelvic floor ultrasound is a reliable method in evaluating preoperational morphological characteristics of patients with SUI. With the help of the 4D pelvic floor ultrasound, the individualized treatment regimen can be developed and, more importantly, the inappropriate surgical decision can be avoided.
压力性尿失禁（SUI）与盆底肌肉功能或形态异常相关，是一种常见病症。本研究旨在探讨四维（4D）盆底超声对临床诊断为SUI的女性患者治疗的影响，并评估其对SUI的临床意义。
我们纳入了51例SUI女性患者。在经闭孔尿道下吊带手术前，患者接受4D盆底超声检查。测量指标包括残余尿量、静息状态下膀胱逼尿肌厚度、静息及瓦尔萨尔瓦动作时膀胱颈至耻骨联合后下缘的垂直距离、膀胱尿道后角以及尿道旋转角度。计算膀胱颈的移动程度（静息状态下膀胱颈至耻骨联合后下缘的垂直距离与最大瓦尔萨尔瓦动作时的差值）以及尿道内口漏斗的形成情况。
膀胱逼尿肌平均厚度为2.6±0.9 mm，膀胱颈至耻骨联合后下缘的垂直距离为27.7±4.5 mm，膀胱后角为122.7±18.9°，直肠壶腹至耻骨联合后下缘的垂直距离为18.5±4.6 mm，肛提肌裂孔平均面积为22.1±6.0 cm。瓦尔萨尔瓦动作时膀胱后角平均为159.3±23.1°，尿道旋转角度平均为67.2±21.4°。
4D盆底超声是评估SUI患者术前形态学特征的可靠方法。借助4D盆底超声，可以制定个体化治疗方案，更重要的是，可以避免不恰当的手术决策。
