Meyer S, De Grandi P, Schreyer A, Caccia G
Department of Gynecology-Obstetrics, CHUV, Lausanne, Switzerland.
Int Urogynecol J Pelvic Floor Dysfunct. 1996;7(3):138-46. doi: 10.1007/BF01894202.
The purpose of this study was to assess the effects of spontaneous and instrumented deliveries, the baby's birthweight, the presence of stress incontinence and the woman's age and weight on bladder neck (BN) position and mobility using perineosonography, a simple non-invasive method, and to compare these results with those from continent nulliparous controls. Two hundred and fourteen women, including 74 nullipara, 29 para-1, 64 para-2 and 3, 16 with previous forceps deliveries and 32 with stress incontinence, underwent perineosonography with measurements of BN position and backwards/downwards displacement of BN using a two-axis calculation system. Results showed that bladder neck position undergoes a significantly backwards and downwards displacement on assuming an upright position. When compared with nulliparous controls, the bladder neck position at rest was the same in all groups of parous women in the supine/standing positions, but lower in patients having undergone forceps delivery (standing position) and in stress incontinent patients (both supine and standing); the bladder neck position during Valsalva was significantly lower in all groups of patients in the standing position, but the only significant difference in the supine position was seen in stress incontinent patients; the extent of bladder neck displacement was not significantly different between the groups, except in stress incontinent patients. A strong correlation (r = 0.66) was found between the relative importance of backwards and downwards displacement, but no correlation was found between bladder neck displacement and baby's birth-weight or patient's weight. It was concluded that compared to nulliparous continent patients, normal and instrumented delivery induces no modifications of BN position at rest, but is responsible for a lower bladder neck position during Valsalva in the standing position only. The extent of BN displacement is virtually the same in all groups of patients in both positions, except for stress incontinent patients, who have a significantly lower and more mobile bladder neck, the values of which overlap to a great extent (sensitivity of 78%/75% for a displacement > 14 mm) within those seen in continent nulliparous women. The correlation between the importance of backwards and downwards displacement is strong, making superfluous a two-dimensional coordinate system for routine BN position/mobility assessment.
本研究旨在采用一种简单的非侵入性方法——会阴超声检查，评估自然分娩和器械助产、婴儿出生体重、压力性尿失禁的存在以及女性年龄和体重对膀胱颈（BN）位置和活动度的影响，并将这些结果与无尿失禁未生育对照者的结果进行比较。214名女性接受了会阴超声检查，其中包括74名未生育女性、29名经产妇、64名经产妇和3名经产妇，16名既往有产钳助产史，32名有压力性尿失禁。使用双轴计算系统测量BN位置以及BN向后/向下移位情况。结果显示，膀胱颈位置在直立位时会显著向后和向下移位。与未生育对照者相比，所有经产妇组在仰卧位/站立位时静息状态下的膀胱颈位置相同，但产钳助产患者（站立位）和压力性尿失禁患者（仰卧位和站立位）的膀胱颈位置较低；所有患者组在站立位进行瓦尔萨尔瓦动作时膀胱颈位置显著更低，但在仰卧位时，仅压力性尿失禁患者有显著差异；除压力性尿失禁患者外，各患者组之间膀胱颈移位程度无显著差异。向后和向下移位的相对重要性之间存在强相关性（r = 0.66），但膀胱颈移位与婴儿出生体重或患者体重之间无相关性。研究得出结论，与无尿失禁未生育患者相比，自然分娩和器械助产在静息状态下不会引起BN位置改变，但仅在站立位进行瓦尔萨尔瓦动作时会导致膀胱颈位置更低。除压力性尿失禁患者外，所有患者组在两个体位下BN移位程度基本相同，压力性尿失禁患者的膀胱颈位置显著更低且活动度更大，其数值在很大程度上与无尿失禁未生育女性的数值重叠（移位>14 mm时敏感性为78%/75%）。向后和向下移位重要性之间的相关性很强，使得用于常规BN位置/活动度评估的二维坐标系变得多余。
