Martan A, Masata J, Halaska M, Voigt R
I. gynek.-porod. klinika 1., Praha.
Ceska Gynekol. 1998 Oct;63(5):363-6.
The prevalence of urinary incontinence varies from 5% in young to 50% in elderly women. The weak anatomical support of the urethrovesical junction, base of the urinary bladder and proximal urethra lead to its prolapse and hypermobility which is considered the main anatomical basis of stress incontinence. The majority of surgical procedures which resolve this problem describes elevation of the cervix of the urinary bladder. The final step of these operations, i.e. how much the urethrovesical junction should be pulled up, is described only rarely and superficially. The clinical consequence which may develop are complications associated with hypercorrection of the posterior urethrovesicular angle, i.e. problems with micturition-difficult micturition, or stage-wise micturition and symptoms of detrusor instability. The objective of the present investigation was: to analyze ultrasonic parameters of the lower urinary tract in women with stress incontinence (GSU), furthermore in women after colpopexy by Burch's method, and with regard to these results, possibly modify the surgical procedure. In the investigation in the first group 30 women were enlisted with confirmed stress incontinence. The second group was formed by 30 women three to nine months after colpopexy. The ultrasound examination was made by the perineal and introital route with the patient in a supine position, using a Acuson 128 XP 10 apparatus with a convex probe with a frequency of 5 MHz and by means of as vaginal probe with a frequency of 7.0 MHz. Assessment of the site and mobility of the urethrovesical junction was made by the transperineal route by means of a convex probe with a 300 ml filling of the urinary bladder; after micturition assessment of the areas of the urethral sphincter in a vertical and horizontal plane followed. In the vertical plane and anterior surface of the sphincter also the blood flow was measured and the pulsatile index (PI) and resistance index (RI) were assessed. The authors investigated also the thickness of the pelvic floor muscles and in the vertical plane the thickness of the urinary bladder wall on the anterior wall, in the vertex and in the area of the trigon. The authors found significant differences in ultrasound parameters in groups of women with GSI and women after colpopexy as regards the site and mobility of the urethrovesical junction and thickness of the urinary bladder wall (p < 0.01). In women with symptoms of urgency after colpopexy the authors found a mean thickness of the urinary bladder wall of more than 5 mm and mean values of the gamma angle smaller than 40 degrees and they recorded also a reduced mobility of the urethrovesical junction. These findings confirmed their expectations that in women with persisting symptoms of urgency frequently slight hypercorrection of the position of the urethrovesical junction is involved. These findings are important for the correction of the surgical approach and the evaluation of the above mentioned parameters is helpful in the diagnosis of urgency.
尿失禁的患病率在年轻女性中为5%，在老年女性中为50%。尿道膀胱连接部、膀胱底部和近端尿道的解剖学支撑薄弱会导致其脱垂和活动过度，这被认为是压力性尿失禁的主要解剖学基础。大多数解决该问题的外科手术都描述了膀胱颈的抬高。这些手术的最后一步，即尿道膀胱连接部应上提多少，很少被详细描述。可能出现的临床后果是与后尿道膀胱角过度矫正相关的并发症，即排尿问题——排尿困难、分次排尿以及逼尿肌不稳定的症状。本研究的目的是：分析压力性尿失禁（GSU）女性、采用伯奇方法行阴道固定术后女性下尿路的超声参数，并根据这些结果可能对手术方法进行调整。在第一项研究中，招募了30名确诊为压力性尿失禁的女性。第二组由30名阴道固定术后三至九个月的女性组成。超声检查通过会阴和阴道途径进行，患者仰卧位，使用配备5MHz凸阵探头的Acuson 128 XP 10仪器以及7.0MHz的阴道探头。通过经会阴途径使用凸阵探头，在膀胱充盈300ml时评估尿道膀胱连接部的位置和活动度；排尿后评估尿道括约肌在垂直和水平平面的区域。在垂直平面和括约肌前表面还测量了血流，并评估了搏动指数（PI）和阻力指数（RI）。作者还研究了盆底肌肉的厚度以及在垂直平面上膀胱前壁、顶部和三角区的膀胱壁厚度。作者发现，在GSU女性组和阴道固定术后女性组中，关于尿道膀胱连接部的位置和活动度以及膀胱壁厚度，超声参数存在显著差异（p<0.01）。在阴道固定术后出现尿急症状的女性中，作者发现膀胱壁平均厚度超过5mm，γ角平均值小于40度，并且他们还记录到尿道膀胱连接部活动度降低。这些发现证实了他们的预期，即持续有尿急症状的女性中，尿道膀胱连接部位置经常存在轻微的过度矫正。这些发现对于纠正手术方法很重要，对上述参数的评估有助于尿急的诊断。
