Shanghai General Hospital, Shanghai, China.
Acta Obstet Gynecol Scand. 2023 Dec;102(12):1661-1673. doi: 10.1111/aogs.14657. Epub 2023 Aug 26.
Stress urinary incontinence (SUI) occurs due to disruption of the pelvic floor anatomy; however, the complexity of the pelvic floor support structures and individual patient differences make it difficult to identify the weak points in the pelvic floor support that cause SUI to occur, develop, and recur. This study aimed to analyze the pelvic floor anatomy, structural features, and biomechanics of cystoceles to develop more effective treatment plans with individualized and precise healthcare.
In this observational case-controlled study (clinical trial identifier BOJI201855L), 102 women with normal pelvic floor function and 273 patients diagnosed with cystocele degrees I-III were identified at Shanghai General Hospital from October 2016 to December 2019. We combined ultrasound and vaginal tactile imaging (VTI) to assess the anatomy and biomechanical functions of the anterior and posterior vaginal walls. Both examinations included relaxation and muscle tension tests.
Of the 42 VTI parameters, 13 were associated with the degree of cystocele, six with an increase in the urethral rotation angle (pointing to the mobility of the urethra), and six with a decrease in the retrovesical angle (pointing to hypsokinesis and decrease in bladder position). According to these data, the strength of tissues, especially the muscles in both the anterior and posterior compartments, contributes to the stability of the pelvic floor structure. The strength of the levator ani muscle (LAM) is important for the degree of cystocele, mobility of the urethra, hypsokinesis, and decrease in bladder position.
In general, the biomechanical status of the pelvic floor in patients with cystocele is complex and involves various muscles, ligaments, tendons, and fascia. Of these, repair and exercise of the LAM have not received much attention in the treatment of patients with cystoceles, which may be an important risk factor for the high recurrence rate.
压力性尿失禁（SUI）是由于骨盆底解剖结构的破坏引起的；然而，骨盆底支持结构的复杂性和个体患者的差异使得难以确定导致 SUI 发生、发展和复发的骨盆底支持的薄弱点。本研究旨在分析膀胱膨出的骨盆底解剖结构、结构特征和生物力学，以制定更有效的治疗计划，实现个体化和精准的医疗保健。
在这项观察性病例对照研究（临床试验标识符 BOJI201855L）中，我们在 2016 年 10 月至 2019 年 12 月期间，在上海总医院确定了 102 名骨盆底功能正常的女性和 273 名被诊断为 I-III 度膀胱膨出的患者。我们结合超声和阴道触觉成像（VTI）评估前壁和后壁的解剖结构和生物力学功能。这两种检查均包括放松和肌肉张力测试。
在 42 个 VTI 参数中，有 13 个与膀胱膨出程度有关，6 个与尿道旋转角度增加（提示尿道活动性增加）有关，6 个与后膀胱角度减小（提示低动力和膀胱位置降低）有关。根据这些数据，组织的强度，特别是前、后盆壁的肌肉强度，有助于骨盆底结构的稳定性。肛提肌（LAM）的强度对膀胱膨出程度、尿道活动性、低动力和膀胱位置降低很重要。
一般来说，膀胱膨出患者的骨盆底生物力学状态较为复杂，涉及到多种肌肉、韧带、肌腱和筋膜。其中，LAM 的修复和锻炼在膀胱膨出患者的治疗中没有得到太多关注，这可能是其高复发率的一个重要危险因素。
