Mal Pierre-André, Metzger Ulrike, Cornier Edgard, Bloomfield Joy, Pizzoferrato Anne-Cécile, Bader Georges
Service de chirurgie gynécologique, hôpital Pitié Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
Centres médicaux-chirurgicaux Ambroise Paré, Hartmann, Pierre Cherest, 26, boulevard Victor-Hugo, 92200 Neuilly-sur-Seine, France; Centre d'échographie de l'Odéon, 122, boulevard Saint-Germain, 75006 Paris, France.
Fr J Urol. 2025 Apr;35(4):102848. doi: 10.1016/j.fjurol.2024.102848. Epub 2024 Dec 21.
Numerous anatomical theories have been developed to explain women stress urinary incontinence (SUI) and improve its management. The transperineal ultrasound is an efficient and non-invasive exam that perfectly studies the bladder neck movement and the urethral anatomy. The measurement of the static portion of the distal urethral length, considered as the functional urethral length (FUL), and of the posterior urethral closure angle (PUCA) have not been studied before and could be of interest.
This prospective case control study compared incontinent and continent patients. Bladder neck descent, FUL and the PUCA were measured at rest and then during Valsalva maneuvers. The correlation between these perineal sonographic criteria and the severity of incontinence was then evaluated.
Fifty patients were included in the study. Bladder neck descent during Valsalva maneuvers was higher in the incontinence group (22.8mm versus 13.5mm, P=0.001). There was not any significant difference in the two groups concerning the FUL and PUCA. Bladder neck descent (ρ=0.36, P<0.05) and urethral funneling during Valsalva maneuvers (ρ=0.37, P<0.05) were significantly correlated to the severity of SUI whereas FUL and the PUCA were not. Bladder neck descent had the best area under the ROC curve (0.7685) for the diagnosis of SUI.
There was no significant correlation between the FUL or the PUCA and the severity of SUI. Bladder neck descent seemed to be the most reliable criteria for the diagnosis of SUI. Several factors may be responsible for a variation in the ultrasound measurements.
为了解释女性压力性尿失禁（SUI）并改善其治疗方法，人们提出了众多解剖学理论。经会阴超声检查是一种高效且无创的检查方法，能够很好地研究膀胱颈的活动及尿道解剖结构。以往尚未对被视为功能性尿道长度（FUL）的尿道远端静态长度及后尿道闭合角（PUCA）进行测量，而这可能具有研究价值。
这项前瞻性病例对照研究对尿失禁患者和尿控正常的患者进行了比较。在静息状态下以及瓦尔萨尔瓦动作过程中测量膀胱颈下移、FUL和PUCA。随后评估这些会阴超声检查标准与尿失禁严重程度之间的相关性。
该研究共纳入50名患者。瓦尔萨尔瓦动作过程中，尿失禁组的膀胱颈下移程度更高（22.8毫米对13.5毫米，P = 0.001）。两组在FUL和PUCA方面没有显著差异。膀胱颈下移（ρ = 0.36，P < 0.05）以及瓦尔萨尔瓦动作过程中的尿道漏斗形成（ρ = 0.37，P < 0.05）与SUI的严重程度显著相关，而FUL和PUCA则不然。膀胱颈下移在诊断SUI时的ROC曲线下面积最大（0.7685）。
FUL或PUCA与SUI的严重程度之间没有显著相关性。膀胱颈下移似乎是诊断SUI最可靠的标准。超声测量结果的差异可能由多种因素导致。
